Georgia 2023-2024 Regular Session

Georgia House Bill HB1339 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	24 HB 1339/AP
2		-	House Bill 1339 (AS PASSED HOUSE AND SENATE)
3		-	By: Representatives Parrish of the 158
4		-	th
5		-	, Burns of the 159
6		-	th
7		-	, Hawkins of the 27
8		-	th
9		-	, Beverly of
10		-	the 143
11		-	rd
12		-	, Taylor of the 173
13		-	rd
14		-	, and others
	1	+	24 LC 33 9707S
	2	+	The Senate Committee on Regulated Industries and Utilities offered the following
	3	+	substitute to HB 1339:
15	4		A BILL TO BE ENTITLED
16	5		AN ACT
17		-	To amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to
18		-	1
19		-	revise provisions relative to certificate of need; to revise definitions; to provide for review2
20		-	of the state health plan every five years; to eliminate capital expenditure thresholds in certain3
	6	+	To amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to1
	7	+	revise relative to certificate of need; to revise definitions; to provide for review of the state2
	8	+	health plan every five years; to eliminate capital expenditure thresholds in certain3
21	9		circumstances; to revise provisions relating to acceptance and review of applications; to4
22	10		provide a timeframe for opposing an application; to revise provisions relating to appeals; to5
23	11		revise exemptions from certificate of need requirements; to provide for a review of the6
24	12		statutory framework of the certificate of need program; to provide for automatic repeal; to7
25	13		increase fines for reporting deficiencies; to amend Code Section 48-7-29.20 of the Official8
26	14		Code of Georgia Annotated, relating to tax credits for contributions to rural hospital9
27	15		organizations, so as to increase the tax credit limit for contributions by corporate donors; to10
28	16		increase the aggregate limit for tax credits for contributions to rural hospital organizations;11
29	17		to provide for preapproval of proportional amounts of contributions under certain12
30	18		circumstances; to provide for certain timelines; to extend the sunset provision; to amend13
31	19		Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to14
32	20		medical assistance generally, so as to provide for the creation of the Comprehensive Health15
33	21		Coverage Commission; to provide for its members; to provide for its purpose and duties; to16
34	22		provide for assistance from experts and consultants; to provide for semiannual reports; to17
35	23		provide for the automatic repeal of the commission; to provide for related matters; to provide18
36		-	H. B. 1339
37		-	- 1 - 24 HB 1339/AP
38		-	for effective dates; to provide for applicability; to repeal conflicting laws; and for other
39		-	19
	24	+	- 1 - 24 LC 33 9707S
	25	+	for effective dates; to provide for applicability; to repeal conflicting laws; and for other19
40	26		purposes.20
41	27		BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:21
42	28		SECTION 1.22
43	29		Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by revising23
44		-	paragraphs (23) and (33) of Code Section 31-6-2, relating to definitions relative to state24
45		-	health planning and development, as follows:25
46		-	"(23) 'Joint venture ambulatory surgical center' means a freestanding ambulatory surgical26
47		-	center that is jointly owned by a hospital in the same county as the center or a hospital in27
48		-	a contiguous county if there is no hospital in the same county as the center and a single28
49		-	group of physicians practicing in the center and that provides surgery in a single specialty29
50		-	as defined by the department. Such ambulatory surgical center shall only be utilized by
51		-	30
52		-	physicians who are of the same single specialty, who may include physicians who are not31
53		-	owners or employees of the single group practice of physicians that own and operate the32
54		-	center; provided, however, that general surgery, a group practice which includes one or33
55		-	more physiatrists who perform services that are reasonably related to the surgical34
56		-	procedures performed in the center, and a group practice in orthopedics which includes35
57		-	plastic hand surgeons with a certificate of added qualifications in Surgery of the Hand36
58		-	from the American Board of Plastic and Reconstructive Surgery shall be considered a37
59		-	single specialty. The ownership interest of the hospital shall be no less than 30 percent38
60		-	and the collective ownership of the physicians or group of physicians shall be no less than39
61		-	30 percent. Nothing in this paragraph shall prohibit the owners of the center from40
62		-	entering into an arrangement with an outside entity for practice management,41
63		-	administrative services, or both."42
64		-	H. B. 1339
65		-	- 2 - 24 HB 1339/AP
66		-	"(33) 'Single specialty ambulatory surgical center' means an ambulatory surgical center
67		-	43
68		-	where surgery is performed in the offices of an individual private physician or single44
69		-	group practice of private physicians if such surgery is performed in a facility that is45
70		-	owned,
71		-	and operated, and utilized by such the individual physician or single group46
72		-	practice of private physicians or single group of physicians who also are of a single47
73		-	specialty. Such ambulatory surgical center shall only be utilized by physicians who are48
74		-	of the same single specialty, who may include physicians who are not owners or49
75		-	employees of the individual private physician or single group practice of private50
76		-	physicians that own and operate the center; provided, however, that general surgery, a51
77		-	group practice which includes one or more physiatrists who perform services that are52
78		-	reasonably related to the surgical procedures performed in the center, and a group53
79		-	practice in orthopedics which includes plastic hand surgeons with a certificate of added54
80		-	qualifications in Surgery of the Hand from the American Board of Plastic and55
81		-	Reconstructive Surgery shall be considered a single specialty. Nothing in this paragraph56
82		-	shall prohibit an individual private physician or a single group practice of private57
83		-	physicians from entering into an arrangement with an outside entity for practice58
84		-	management, administrative services, or both."59
85		-	SECTION 2.60
86		-	Said title is further amended in Code Section 31-6-21, relating to Department of Community61
87		-	Health functions and powers with respect to state health planning and development, by62
88		-	revising subsection (a) as follows:63
89		-	"(a) The Department of Community Health, established under Chapter 2 of this title, is64
90		-	authorized to administer the certificate of need program established under this chapter and,65
91		-	within the appropriations made available to the department by the General Assembly of66
92		-	Georgia and consistently with the laws of the State of Georgia, a state health plan adopted67
93		-	by the board. The department shall review and update the state health plan at least every68
94		-	H. B. 1339
95		-	- 3 - 24 HB 1339/AP
96		-	five years beginning no later than January 1, 2025, to ensure the plan meets the evolving69
97		-	needs of the state. The department shall provide, by rule, for procedures to administer its70
98		-	functions until otherwise provided by the board."71
99		-	SECTION 3.72
100		-	Said title is further amended in Code Section 31-6-40, relating to certificate of need required73
101		-	for new institutional health services and exemption, by revising subsections (a), (b), and (c)74
102		-	as follows:75
103		-	"(a) On and after July 1, 2008, any new institutional health service shall be required to76
104		-	obtain a certificate of need pursuant to this chapter. New institutional health services77
105		-	include:78
106		-	(1) The construction, development, or other establishment of a new, expanded, or79
107		-	relocated health care facility, except as otherwise provided in Code Section 31-6-47;80
108		-	(2) Any expenditure by or on behalf of a health care facility in excess of $10 million81
109		-	which, under generally accepted accounting principles consistently applied, is a capital82
110		-	expenditure, except expenditures for acquisition of an existing health care facility. The83
111		-	dollar amounts specified in this paragraph and in paragraph (14) of Code Section 31-6-284
112		-	shall be adjusted annually by an amount calculated by multiplying such dollar amounts85
113		-	(as adjusted for the preceding year) by the annual percentage of change in the composite86
114		-	index of construction material prices, or its successor or appropriate replacement index,87
115		-	if any, published by the United States Department of Commerce for the preceding88
116		-	calendar year, commencing on July 1, 2019, and on each anniversary thereafter of89
117		-	publication of the index. The department shall immediately institute rule-making90
118		-	procedures to adopt such adjusted dollar amounts. In calculating the dollar amounts of91
119		-	a proposed project for purposes of this paragraph and paragraph (14) of Code Section92
120		-	31-6-2, the costs of all items subject to review by this chapter and items not subject to93
121		-	review by this chapter associated with and simultaneously developed or proposed with94
122		-	H. B. 1339
123		-	- 4 - 24 HB 1339/AP
124		-	the project shall be counted, except for the expenditure or commitment of or incurring an95
125		-	obligation for the expenditure of funds to develop certificate of need applications, studies,96
126		-	reports, schematics, preliminary plans and specifications or working drawings, or to97
127		-	acquire sites; Reserved;98
128		-	(3) The purchase or lease by or on behalf of a health care facility or a diagnostic,99
129		-	treatment, or rehabilitation center of diagnostic or therapeutic equipment, except as100
130		-	otherwise provided in Code Section 31-6-47;101
131		-	(4) Any increase in the bed capacity of a health care facility except as provided in Code102
132		-	Section 31-6-47;103
133		-	(5) Clinical health services which are offered in or through a health care facility, which104
134		-	were not offered on a regular basis in or through such health care facility within the 12105
135		-	month period prior to the time such services would be offered;106
136		-	(6) Any conversion or upgrading of any general acute care hospital to a specialty hospital107
137		-	or of a facility such that it is converted from a type of facility not covered by this chapter108
138		-	to any of the types of health care facilities which are covered by this chapter;109
139		-	(7) Clinical health services which are offered in or through a diagnostic, treatment, or110
140		-	rehabilitation center which were not offered on a regular basis in or through that center111
141		-	within the 12 month period prior to the time such services would be offered, but only if112
142		-	the clinical health services are any of the following:113
143		-	(A) Radiation therapy;114
144		-	(B) Biliary lithotripsy;115
145		-	(C) Surgery in an operating room environment, including, but not limited to,116
146		-	ambulatory surgery; and117
147		-	(D) Cardiac catheterization; and118
148		-	(8) The conversion of a destination cancer hospital to a general cancer hospital.119
149		-	(b) Any person proposing to develop or offer a new institutional health service or health120
150		-	care facility shall, before commencing such activity, submit a letter of intent and an121
151		-	H. B. 1339
152		-	- 5 - 24 HB 1339/AP
153		-	application to the department and obtain a certificate of need in the manner provided in this
154		-	122
155		-	chapter unless such activity is excluded from the scope of this chapter.123
156		-	(c)(1) Any person who had a valid exemption granted or approved by the former Health124
157		-	Planning Agency or the department prior to July 1, 2008, shall not be required to obtain125
158		-	a certificate of need in order to continue to offer those previously offered services.126
159		-	(2) Any facility offering ambulatory surgery pursuant to the exclusion designated on127
160		-	June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2; any diagnostic, treatment,128
161		-	or rehabilitation center offering diagnostic imaging or other imaging services in operation129
162		-	and exempt prior to July 1, 2008; or any facility operating pursuant to a letter of130
163		-	nonreviewability and offering diagnostic imaging services prior to July 1, 2008, shall:131
164		-	(A) Provide annual reports in the same manner and in accordance with Code Section132
165		-	31-6-70; and133
166		-	(B)(i) Provide care to Medicaid beneficiaries and, if the facility provides medical care134
167		-	and treatment to children, to PeachCare for Kids beneficiaries and provide135
168		-	uncompensated indigent and charity care in an amount equal to or greater than 2136
169		-	percent of its adjusted gross revenue, and on and after January 1, 2026, in an amount
170		-	137
171		-	equal to or greater than the minimum amount established by the department which138
172		-	shall be reviewed by the department every 12 months; or139
173		-	(ii) If the facility is not a participant in Medicaid or the PeachCare for Kids Program,140
174		-	provide uncompensated care for Medicaid beneficiaries and, if the facility provides141
175		-	medical care and treatment to children, for PeachCare for Kids beneficiaries,142
176		-	uncompensated indigent and charity care, or both in an amount equal to or greater143
177		-	than 4 percent of its adjusted gross revenue, and on and after January 1, 2026, in an144
178		-	amount equal to or greater than the minimum amount established by the department145
179		-	which shall be reviewed by the department every 12 months, if it:146
180		-	(I) Makes a capital expenditure associated with the construction, development,147
181		-	expansion, or other establishment of a clinical health service or the acquisition or148
182		-	H. B. 1339
183		-	- 6 - 24 HB 1339/AP
184		-	replacement of diagnostic or therapeutic equipment with a value in excess of
185		-	149
186		-	$800,000.00 over a two-year period;150
187		-	(II) Builds a new operating room; or151
188		-	(III) Chooses to relocate in accordance with Code Section 31-6-47.152
189		-	Noncompliance with any condition of this paragraph shall result in a monetary penalty153
190		-	in the amount of the difference between the services which the center is required to154
191		-	provide and the amount actually provided and may be subject to revocation of its155
192		-	exemption status by the department for repeated failure to pay any fees or moneys due156
193		-	to the department or for repeated failure to produce data as required by Code Section157
194		-	31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of158
195		-	Title 50, the 'Georgia Administrative Procedure Act.' The dollar amount specified in this159
196		-	paragraph shall be adjusted annually by an amount calculated by multiplying such dollar160
197		-	amount (as adjusted for the preceding year) by the annual percentage of change in the161
198		-	consumer price index, or its successor or appropriate replacement index, if any, published162
199		-	by the United States Department of Labor for the preceding calendar year, commencing163
200		-	on July 1, 2009. In calculating the dollar amounts of a proposed project for the purposes164
201		-	of this paragraph, the costs of all items subject to review by this chapter and items not165
202		-	subject to review by this chapter associated with and simultaneously developed or166
203		-	proposed with the project shall be counted, except for the expenditure or commitment of167
204		-	or incurring an obligation for the expenditure of funds to develop certificate of need168
205		-	applications, studies, reports, schematics, preliminary plans and specifications or working169
206		-	drawings, or to acquire sites. Subparagraph (B) of this paragraph shall not apply to170
207		-	facilities offering ophthalmic ambulatory surgery pursuant to the exclusion designated171
208		-	on June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2 that are owned by172
209		-	physicians in the practice of ophthalmology."173
210		-	SECTION 4.174
211		-	H. B. 1339
212		-	- 7 - 24 HB 1339/AP
213		-	Said title is further amended by revising Code Section 31-6-43, relating to acceptance or
214		-	175
215		-	rejection of application for certificate, as follows:176
216		-	"31-6-43.177
217		-	(a) At least 30
218		-	25 days prior to submitting an application for a certificate of need for178
219		-	clinical health services, a person shall submit a letter of intent to the department. The179
220		-	department shall provide by rule a process for submitting letters of intent and a mechanism180
221		-	by which applications may be filed to compete with and be reviewed comparatively with181
222		-	proposals described in submitted letters of intent.182
223		-	(b) Each application for a certificate of need shall be reviewed received by the department,183
224		-	and within ten working days after the date of its receipt a determination shall be made as184
225		-	to whether the application complies with the rules governing the preparation and185
226		-	submission of applications. If the application complies with the rules governing the186
227		-	preparation and submission of applications, and the department shall declare the187
228		-	application complete for review, shall accept and date the application, and shall notify the188
229		-	applicant of the timetable for its review. The department shall also notify a newspaper of189
230		-	general circulation in the county in which the project shall be developed that the190
231		-	application has been deemed complete. The department shall also notify the appropriate191
232		-	regional commission and the chief elected official of the county and municipal192
233		-	governments, if any, in whose boundaries the proposed project will be located that the193
234		-	application is complete for review. If the application does not comply with the rules194
235		-	governing the preparation and submission of applications, the department shall notify the195
236		-	applicant in writing and provide a list of all deficiencies. The applicant shall be afforded196
237		-	an opportunity to correct such deficiencies, and upon such correction, the application shall197
238		-	then be declared complete for review within ten days of the correction of such deficiencies,198
239		-	and notice given to a newspaper of general circulation in the county in which the project199
240		-	shall be developed that the application has been so declared. The department shall also200
241		-	notify the appropriate regional commission and the chief elected official of the county and201
242		-	H. B. 1339
243		-	- 8 - 24 HB 1339/AP
244		-	municipal governments, if any, in whose boundaries the proposed project will be located
245		-	202
246		-	that the application is complete for review or when in the determination of the department203
247		-	a significant amendment is filed.204
248		-	(c) The department shall specify by rule the time within which an applicant may amend205
249		-	its application. The department may request an applicant to make amendments. The206
250		-	department decision shall be made on an application as amended, if at all, by the applicant.207
251		-	(d)(1) There shall be a time limit of 120 days for review of a project, beginning on the208
252		-	day the department declares the application complete for review or in the case of
253		-	209
254		-	applications joined for comparative review, beginning on the day the department declares210
255		-	the final application complete receives the application. The department may adopt rules211
256		-	for determining when it is not practicable to complete a review in 120 days and may212
257		-	extend the review period upon written notice to the applicant but only for an extended213
258		-	period of not longer than an additional 30 days. The department shall adopt rules214
259		-	governing the submission of additional information by the applicant and for opposing an215
260		-	application; provided, however, that such rules shall provide that any party permitted to216
261		-	oppose an application shall submit a notice of opposition no later than 30 days of receipt217
262		-	by the department of such application.218
263		-	(2) No party may oppose an application for a certificate of need for a proposed project219
264		-	unless:220
265		-	(A) Such party offers substantially similar services as proposed within a 35 mile radius221
266		-	of the proposed project or has a service area that overlaps the applicant's proposed222
267		-	service area; or223
268		-	(B) Such party has submitted a competing application in the same batching cycle and224
269		-	is proposing to establish the same type of facility proposed or offers substantially225
270		-	similar services as proposed and has a service area that overlaps the applicant's226
271		-	proposed service area.227
272		-	H. B. 1339
273		-	- 9 - 24 HB 1339/AP
274		-	(e) To allow the opportunity for comparative review of applications, the department may
275		-	228
276		-	provide by rule for applications for a certificate of need to be submitted on a timetable or229
277		-	batching cycle basis no less often than two times per calendar year for each clinical health230
278		-	service. Applications for services, facilities, or expenditures for which there is no specified231
279		-	batching cycle may be filed at any time.232
280		-	(f) The department may order the joinder of an application which is determined to be233
281		-	complete by the department for comparative review with one or more subsequently filed234
282		-	applications declared complete for review during the same batching cycle when:235
283		-	(1) The first and subsequent applications involve similar clinical health service projects236
284		-	in the same service area or overlapping service areas; and237
285		-	(2) The subsequent applications are filed and are declared complete for review within 30238
286		-	days of the date the first application was declared complete for review.239
287		-	Following joinder of the first application with subsequent applications, none of the240
288		-	subsequent applications so joined may be considered as a first application for the purposes241
289		-	of future joinder. The department shall notify the applicant to whose application a joinder242
290		-	is ordered and all other applicants previously joined to such application of the fact of each243
291		-	joinder pursuant to this subsection. In the event one or more applications have been joined244
292		-	pursuant to this subsection, the time limits for department action for all of the applicants245
293		-	shall run from the latest date that any one of the joined applications was declared complete246
294		-	for review. In the event of the consideration of one or more applications joined pursuant247
295		-	to this subsection, the department may award no certificate of need or one or more248
296		-	certificates of need to the application or applications, if any, which are consistent with the249
297		-	considerations contained in Code Section 31-6-42, the department's applicable rules, and250
298		-	the award of which will best satisfy the purposes of this chapter.251
299		-	(g) The department shall review the application and all written information submitted by252
300		-	the applicant in support of the application and all information submitted in opposition to253
301		-	the application to determine the extent to which the proposed project is consistent with the254
302		-	H. B. 1339
303		-	- 10 - 24 HB 1339/AP
304		-	applicable considerations stated in Code Section 31-6-42 and in the department's applicable
305		-	255
306		-	rules. During the course of the review, the department staff may request additional256
307		-	information from the applicant as deemed appropriate. Pursuant to rules adopted by the257
308		-	department, a public hearing on applications covered by those regulations may be held258
309		-	prior to the date of the department's decision thereon. Such rules shall provide that when259
310		-	good cause has been shown, a public hearing shall be held by the department. Any260
311		-	interested person may submit information to the department concerning an application, and261
312		-	an applicant shall be entitled to notice of and to respond to any such submission.262
313		-	(h) The department shall within 30 days of receipt of the application
314		-	provide the applicant263
315		-	an opportunity to meet with the department to discuss the such application and to provide264
316		-	the applicant an opportunity to submit additional information. Such additional information265
317		-	shall be submitted within the time limits adopted by the department. The department shall266
318		-	also provide an opportunity for any party that is permitted to oppose an application267
319		-	pursuant to paragraph (2) of subsection (d) of this Code section to meet with the268
320		-	department and to provide additional information to the department. In order for any such269
321		-	opposing party to have standing to appeal an adverse decision pursuant to Code Section270
322		-	31-6-44, such party must attend and participate in an opposition meeting.271
323		-	(i) Unless extended by the department for an additional period of up to 30 days pursuant272
324		-	to subsection (d) of this Code section, the department shall, no later than 120 days after an273
325		-	application is determined to be complete for review, or, in the event of joined applications,274
326		-	120 days after the last application is declared complete for review, provide written275
327		-	notification to an applicant of the department's decision to issue or to deny issuance of a276
328		-	certificate of need for the proposed project. Such notice shall contain the department's277
329		-	written findings of fact and decision as to each applicable consideration or rule and a278
330		-	detailed statement of the reasons and evidentiary support for issuing or denying a certificate279
331		-	of need for the action proposed by each applicant. The department shall also mail such280
332		-	notification to the appropriate regional commission and the chief elected official of the281
333		-	H. B. 1339
334		-	- 11 - 24 HB 1339/AP
335		-	county and municipal governments, if any, in whose boundaries the proposed project will
336		-	282
337		-	be located. In the event such decision is to issue a certificate of need, the certificate of283
338		-	need shall be effective on the day of the decision unless the decision is appealed to the284
339		-	Certificate of Need Appeal Panel in accordance with this chapter. Within seven days of285
340		-	the decision, the department shall publish notice of its decision to grant or deny an286
341		-	application in the same manner as it publishes notice of the filing of an application.287
342		-	(j) Should the department fail to provide written notification of the decision within the288
343		-	time limitations set forth in this Code section, an application shall be deemed to have been289
344		-	approved as of the one hundred twenty-first day following notice from the department that290
345		-	an application, or the last of any applications joined pursuant to subsection (f) of this Code291
346		-	section, is declared 'complete for review.'292
347		-	(k) Notwithstanding other provisions of this article, when the Governor has declared a293
348		-	state of emergency in a region of the state, existing health care facilities in the affected294
349		-	region may seek emergency approval from the department to make expenditures in excess
350		-	295
351		-	of the capital expenditure threshold or to offer services that may otherwise require a296
352		-	certificate of need. The department shall give special expedited consideration to such297
353		-	requests and may authorize such requests for good cause. Once the state of emergency has298
354		-	been lifted, any services offered by an affected health care facility under this subsection299
355		-	shall cease to be offered until such time as the health care facility that received the300
356		-	emergency authorization has requested and received a certificate of need. For purposes of301
357		-	this subsection, the term 'good cause' means that authorization of the request shall directly302
358		-	resolve a situation posing an immediate threat to the health and safety of the public. The303
359		-	department shall establish, by rule, procedures whereby requirements for the process of304
360		-	review and issuance of a certificate of need may be modified and expedited as a result of305
361		-	emergency situations."306
362		-	SECTION 5.307
363		-	H. B. 1339
364		-	- 12 - 24 HB 1339/AP
365		-	Said title is further amended by revising subsections (h), (i), (j), (k), (l), (m), and (n) of Code
366		-	308
367		-	Section 31-6-44, relating to the Certificate of Need Appeal Panel, as follows:309
368		-	"(h) After the issuance of a decision by the department pursuant to Code Section 31-6-43,310
369		-	no party to an appeal hearing, nor any person on behalf of such party, including the311
370		-	department, shall make any ex parte contact with the appeal panel hearing officer appointed312
371		-	to conduct the appeal hearing,
372		-	or any other member of the appeal panel, or the313
373		-	commissioner in regard to a decision under appeal.314
374		-	(i) Within 30 days after the conclusion of the hearing, the hearing officer shall make315
375		-	written findings of fact and conclusions of law as to each consideration as set forth in Code316
376		-	Section 31-6-42 and the department's rules, including a detailed statement of the reasons317
377		-	for the decision of the hearing officer. If any party has alleged that an appeal lacks318
378		-	substantial justification or was undertaken primarily for the purpose of delay or harassment,319
379		-	the decision of the hearing officer shall make findings of fact addressing the merits of the320
380		-	allegation. The hearing officer shall file such decision with the chairperson of the appeal321
381		-	panel who shall serve such decision upon all parties, and shall transmit the administrative322
382		-	record to the commissioner department. Any party, including the department, which323
383		-	disputes any finding of fact or conclusion of law rendered by the hearing officer in such324
384		-	hearing officer's decision and which wishes to appeal that decision may appeal to the325
385		-	commissioner and shall file its specific objections with the commissioner or his or her326
386		-	designee within 30 days of the date of the hearing officer's decision pursuant to rules327
387		-	adopted by the department.328
388		-	(j) The decision of the appeal panel hearing officer will become shall constitute the final329
389		-	decision of the department upon the sixty-first day following the date of the decision unless330
390		-	an objection thereto is filed with the commissioner within the time limit established in331
391		-	subsection (i) of this Code section.332
392		-	(k)(1) In the event an appeal of the hearing officer's decision is filed, the commissioner333
393		-	may adopt the hearing officer's order as the final order of the department or the334
394		-	H. B. 1339
395		-	- 13 - 24 HB 1339/AP
396		-	commissioner may reject or modify the conclusions of law over which the department has335
397		-	substantive jurisdiction and the interpretation of administrative rules over which it has336
398		-	substantive jurisdiction. By rejecting or modifying such conclusion of law or337
399		-	interpretation of administrative rule, the department must state with particularity its338
400		-	reasons for rejecting or modifying such conclusion of law or interpretation of339
401		-	administrative rule and must make a finding that its substituted conclusion of law or340
402		-	interpretation of administrative rule is as or more reasonable than that which was rejected341
403		-	or modified. Rejection or modification of conclusions of law may not form the basis for342
404		-	rejection or modification of findings of fact. The commissioner may not reject or modify343
405		-	the findings of fact unless the commissioner first determines from a review of the entire344
406		-	record, and states with particularity in the order, that the findings of fact were not based345
407		-	upon any competent substantial evidence or that the proceedings on which the findings346
408		-	were based did not comply with the essential requirements of law.347
409		-	(2) If, before the date set for the commissioner's decision, application is made to the348
410		-	commissioner for leave to present additional evidence and it is shown to the satisfaction349
411		-	of the commissioner that the additional evidence is material and there were good reasons350
412		-	for failure to present it in the proceedings before the hearing officer, the commissioner351
413		-	may order that the additional evidence be taken before the same hearing officer who352
414		-	rendered the initial decision upon conditions determined by the commissioner. The353
415		-	hearing officer may modify the initial decision by reason of the additional evidence and354
416		-	shall file that evidence and any modifications, new findings, or decision with the355
417		-	commissioner. Unless leave is given by the commissioner in accordance with the356
418		-	provisions of this subsection, the appeal panel may not consider new evidence under any357
419		-	circumstances. In all circumstances, the commissioner's decision shall be based upon358
420		-	considerations as set forth in Code Section 31-6-42 and the department's rules.359
421		-	(l) If, based upon the findings of fact by the hearing officer, the commissioner determines360
422		-	that the appeal filed by any party of a decision of the department lacks substantial361
423		-	H. B. 1339
424		-	- 14 - 24 HB 1339/AP
425		-	justification and was undertaken primarily for the purpose of delay or harassment, the362
426		-	commissioner may enter an award in his or her written order against such party and in363
427		-	favor of the successful party or parties, including the department, of all or any part of their364
428		-	respective reasonable and necessary attorney's fees and expenses of litigation, as the365
429		-	commissioner deems just. Such award may be enforced by any court undertaking judicial366
430		-	review of the final decision. In the absence of any petition for judicial review, then such367
431		-	award shall be enforced, upon due application, by any court having personal jurisdiction368
432		-	over the party against whom such an award is made.369
433		-	(m) Unless the hearing officer's decision becomes the department's final decision by370
434		-	operation of law as provided in subsection (j) of this Code section, the decision of the371
435		-	commissioner shall become the department's final decision by operation of law. Such final372
436		-	decision shall be the final department decision for purposes of Chapter 13 of Title 50, the373
437		-	'Georgia Administrative Procedure Act.' The appeals process provided by this Code374
438		-	section shall be the administrative remedy only for decisions made by the department375
439		-	pursuant to Code Section 31-6-43 which involve the approval or denial of applications for376
440		-	certificates of need.377
441		-	(n) A party responding to an appeal to the commissioner may be entitled to reasonable378
442		-	attorney's fees and costs of such appeal if it is determined that the appeal lacked substantial379
443		-	justification and was undertaken primarily for the purpose of delay or harassment;380
444		-	provided, however, that the department shall not be required to pay attorney's fees or costs.381
445		-	This subsection shall not apply to the portion of attorney's fees accrued on behalf of a party382
446		-	responding to or bringing a challenge to the department's authority to enact a rule or383
447		-	regulation or the department's jurisdiction or another challenge that could not have been384
448		-	decided in the administrative proceeding, nor shall it apply to costs accrued when the only385
449		-	argument raised by the appealing party is one described in this subsection."386
450		-	SECTION 6.387
451		-	H. B. 1339
452		-	- 15 - 24 HB 1339/AP
453		-	Said title is further amended by revising subsection (a) of Code Section 31-6-44.1, relating
454		-	388
455		-	to judicial review, as follows:389
456		-	"(a) Any party to the initial administrative appeal hearing conducted by the appointed390
457		-	appeal panel hearing officer, excluding the department, may seek judicial review of the391
458		-	final decision in accordance with the method set forth in Chapter 13 of Title 50, the392
459		-	'Georgia Administrative Procedure Act,' except as otherwise modified by this Code section;393
460		-	provided, however, that in conducting such review, the court may reverse or modify the394
461		-	final decision only if substantial rights of the appellant have been prejudiced because the395
462		-	procedures followed by the department,
463		-	or the hearing officer, or the commissioner or the396
464		-	administrative findings, inferences, and conclusions contained in the final decision are:397
465		-	(1) In violation of constitutional or statutory provisions;398
466		-	(2) In excess of the statutory authority of the department;399
467		-	(3) Made upon unlawful procedures;400
468		-	(4) Affected by other error of law;401
469		-	(5) Not supported by substantial evidence, which shall mean that the record does not402
470		-	contain such relevant evidence as a reasonable mind might accept as adequate to support403
471		-	such findings, inferences, conclusions, or decisions, which such evidentiary standard shall404
472		-	be in excess of the 'any evidence' standard contained in other statutory provisions; or405
473		-	(6) Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted406
474		-	exercise of discretion."407
475		-	SECTION 7.408
476		-	Said title is further amended by revising Code Section 31-6-47, relating to exemptions from409
477		-	certificate of need requirements, as follows:410
478		-	"31-6-47.411
479		-	(a) Notwithstanding the other provisions of this chapter, this chapter shall not apply to:412
480		-	H. B. 1339
481		-	- 16 - 24 HB 1339/AP
482		-	(1) Infirmaries operated by educational institutions for the sole and exclusive benefit of
483		-	413
484		-	students, faculty members, officers, or employees thereof;414
485		-	(2) Infirmaries or facilities operated by businesses for the sole and exclusive benefit of415
486		-	officers or employees thereof, provided that such infirmaries or facilities make no416
487		-	provision for overnight stay by persons receiving their services;417
488		-	(3) Institutions operated exclusively by the federal government or by any of its agencies;418
489		-	(4) Offices of private physicians or dentists whether for individual or group practice,419
490		-	except as otherwise provided in paragraph (3) or (7) of subsection (a) of Code420
491		-	Section 31-6-40;421
492		-	(5) Religious, nonmedical health care institutions as defined in 42 U.S.C.422
493		-	Section 1395x(ss)(1), listed and certified by a national accrediting organization;423
494		-	(6) Site acquisitions for health care facilities or preparation or development costs for424
495		-	such sites prior to the decision to file a certificate of need application;425
496		-	(7) Expenditures related to adequate preparation and development of an application for426
497		-	a certificate of need;427
498		-	(8) The commitment of funds conditioned upon the obtaining of a certificate of need;428
499		-	(9) Expenditures for the restructuring or acquisition of existing health care facilities by429
500		-	stock or asset purchase, merger, consolidation, or other lawful means;430
501		-	(9.1) The purchase of a closing hospital or of a hospital that has been closed for no more431
502		-	than 12
503		-	24 months by a hospital in a contiguous county to repurpose the facility as a432
504		-	micro-hospital;433
505		-	(10) Expenditures of less than $870,000.00 for any minor or major repair or replacement434
506		-	of The acquisition, replacement, or repair of diagnostic, therapeutic, or other imaging435
507		-	equipment by a any existing health care facility that is not owned by a group practice of436
508		-	physicians or a hospital and that provides diagnostic imaging services so long as it does437
509		-	not result in the offering of any new clinical health services if such facility received a438
510		-	H. B. 1339
511		-	- 17 - 24 HB 1339/AP
512		-	letter of nonreviewability from the department prior to July 1, 2008. This paragraph shall439
513		-	not apply to such facilities in rural counties;440
514		-	(10.1) Except as provided in paragraph (10) of this subsection, An expenditure for the441
515		-	minor or major repair of a health care facility or a facility that is exempt from the442
516		-	requirements of this chapter, parts thereof, or services provided or equipment used443
517		-	therein; or the replacement of equipment, including but not limited to CT scanners,444
518		-	magnetic resonance imaging, positron emission tomography (PET), and positron445
519		-	emission tomography/computed tomography previously approved for a certificate of446
520		-	need;447
521		-	(11) Capital expenditures otherwise covered by this chapter required solely to eliminate448
522		-	or prevent safety hazards as defined by federal, state, or local fire, building,449
523		-	environmental, occupational health, or life safety codes or regulations, to comply with450
524		-	licensing requirements of the department, or to comply with accreditation standards of451
525		-	a nationally recognized health care accreditation body;452
526		-	(12) Cost overruns whose percentage of the cost of a project is equal to or less than the453
527		-	cumulative annual rate of increase in the composite construction index, published by the454
528		-	United States Bureau of the Census of the Department of Commerce, calculated from the455
529		-	date of approval of the project;456
530		-	(13) Transfers from one health care facility to another such facility of major medical457
531		-	equipment previously approved under or exempted from certificate of need review,458
532		-	except where such transfer results in the institution of a new clinical health service for459
533		-	which a certificate of need is required in the facility acquiring such equipment, provided460
534		-	that such transfers are recorded at net book value of the medical equipment as recorded461
535		-	on the books of the transferring facility;462
536		-	(14) New institutional health services provided by or on behalf of health maintenance463
537		-	organizations or related health care facilities in circumstances defined by the department464
538		-	pursuant to federal law;465
539		-	H. B. 1339
540		-	- 18 - 24 HB 1339/AP
541		-	(15) Increases in the bed capacity of a hospital up to ten beds or 10 20 percent of466
542		-	capacity, whichever is greater, in any consecutive two-year three-year period, in a467
543		-	hospital that has maintained an overall occupancy rate greater than 75 60 percent for the468
544		-	previous 12 month period;469
545		-	(16) Expenditures for nonclinical projects, including parking lots, parking decks, and470
546		-	other parking facilities; computer systems, software, and other information technology;471
547		-	medical office buildings; administrative office space; conference rooms; education472
548		-	facilities; lobbies; common spaces; clinical staff lounges and sleep areas; waiting rooms;473
549		-	bathrooms; cafeterias; hallways; engineering facilities; mechanical systems; roofs;474
550		-	grounds; signage; family meeting or lounge areas; other nonclinical physical plant475
551		-	renovations or upgrades that do not result in new or expanded clinical health services, and476
552		-	state mental health facilities;477
553		-	(17) Life plan communities, provided that the skilled nursing component of the facility478
554		-	is for the exclusive use of residents of the life plan community and that a written479
555		-	exemption is obtained from the department; provided, however, that new sheltered480
556		-	nursing home beds may be used on a limited basis by persons who are not residents of481
557		-	the life plan community for a period up to five years after the date of issuance of the482
558		-	initial nursing home license, but such beds shall not be eligible for Medicaid483
559		-	reimbursement. For the first year, the life plan community sheltered nursing facility may484
560		-	utilize not more than 50 percent of its licensed beds for patients who are not residents of485
561		-	the life plan community. In the second year of operation, the life plan community shall486
562		-	allow not more than 40 percent of its licensed beds for new patients who are not residents487
563		-	of the life plan community. In the third year of operation, the life plan community shall488
564		-	allow not more than 30 percent of its licensed beds for new patients who are not residents489
565		-	of the life plan community. In the fourth year of operation, the life plan community shall490
566		-	allow not more than 20 percent of its licensed beds for new patients who are not residents491
567		-	of the life plan community. In the fifth year of operation, the life plan community shall492
568		-	H. B. 1339
569		-	- 19 - 24 HB 1339/AP
570		-	allow not more than 10 percent of its licensed beds for new patients who are not residents
571		-	493
572		-	of the life plan community. At no time during the first five years shall the life plan494
573		-	community sheltered nursing facility occupy more than 50 percent of its licensed beds495
574		-	with patients who are not residents under contract with the life plan community. At the496
575		-	end of the five-year period, the life plan community sheltered nursing facility shall be497
576		-	utilized exclusively by residents of the life plan community, and at no time shall a498
577		-	resident of a life plan community be denied access to the sheltered nursing facility. At499
578		-	no time shall any existing patient be forced to leave the life plan community to comply500
579		-	with this paragraph. The department is authorized to promulgate rules and regulations501
580		-	regarding the use and definition of the term
581		-	'sheltered nursing facility' in a manner502
582		-	consistent with this Code section. Agreements to provide continuing care include503
583		-	agreements to provide care for any duration, including agreements that are terminable by504
584		-	either party;505
585		-	(18) Any single specialty ambulatory surgical center that:506
586		-	(A)(i) Has capital expenditures associated with the construction, development, or507
587		-	other establishment of the clinical health service which do not exceed $2.5 million;508
588		-	or509
589		-	(ii) Is the only single specialty ambulatory surgical center in the county owned by the510
590		-	group practice and has two or fewer operating rooms; provided, however, that a center511
591		-	exempt pursuant to this division shall be required to obtain a certificate of need in512
592		-	order to add any additional operating rooms;513
593		-	(B) Has a hospital affiliation agreement with a hospital within a reasonable distance514
594		-	from the facility or the medical staff at the center has admitting privileges or other515
595		-	acceptable documented arrangements with such hospital to ensure the necessary backup516
596		-	for the center for medical complications. The center shall have the capability to transfer517
597		-	a patient immediately to a hospital within a reasonable distance from the facility with518
598		-	H. B. 1339
599		-	- 20 - 24 HB 1339/AP
600		-	adequate emergency room services. Hospitals shall not unreasonably deny a transfer
601		-	519
602		-	agreement or affiliation agreement to
603		-	with the center;520
604		-	(C)(i) Provides care to Medicaid beneficiaries and, if the facility provides medical521
605		-	care and treatment to children, to PeachCare for Kids beneficiaries and provides522
606		-	uncompensated indigent and charity care in an amount equal to or greater than 2523
607		-	percent of its adjusted gross revenue, and on and after January 1, 2026, in an amount524
608		-	equal to or greater than the minimum amount established by the department which525
609		-	shall be reviewed by the department every 12 months; or526
610		-	(ii) If the center is not a participant in Medicaid or the PeachCare for Kids Program,527
611		-	provides uncompensated care to Medicaid beneficiaries and, if the facility provides528
612		-	medical care and treatment to children, to PeachCare for Kids beneficiaries,529
613		-	uncompensated indigent and charity care, or both in an amount equal to or greater530
614		-	than 4 percent of its adjusted gross revenue, and on and after January 1, 2026, in an531
615		-	amount equal to or greater than the minimum amount established by the department532
616		-	which shall be reviewed by the department every 12 months;533
617		-	provided, however, that single specialty ambulatory surgical centers owned by534
618		-	physicians in the practice of ophthalmology shall not be required to comply with this535
619		-	subparagraph; and536
620		-	(D) Provides annual reports in the same manner and in accordance with Code537
621		-	Section 31-6-70.538
622		-	Noncompliance with any condition of this paragraph shall result in a monetary penalty539
623		-	in the amount of the difference between the services which the center is required to540
624		-	provide and the amount actually provided and may be subject to revocation of its541
625		-	exemption status by the department for repeated failure to pay any fines or moneys due542
626		-	to the department or for repeated failure to produce data as required by Code Section543
627		-	31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of544
628		-	Title 50, the 'Georgia Administrative Procedure Act.' The dollar amount specified in this545
629		-	H. B. 1339
630		-	- 21 - 24 HB 1339/AP
631		-	paragraph shall be adjusted annually by an amount calculated by multiplying such dollar
632		-	546
633		-	amount (as adjusted for the preceding year) by the annual percentage of change in the547
634		-	composite index of construction material prices, or its successor or appropriate548
635		-	replacement index, if any, published by the United States Department of Commerce for549
636		-	the preceding calendar year, commencing on July 1, 2009, and on each anniversary550
637		-	thereafter of publication of the index. The department shall immediately institute551
638		-	rule-making procedures to adopt such adjusted dollar amounts. In calculating the dollar552
639		-	amounts of a proposed project for purposes of this paragraph, the costs of all items553
640		-	subject to review by this chapter and items not subject to review by this chapter554
641		-	associated with and simultaneously developed or proposed with the project shall be555
642		-	counted, except for the expenditure or commitment of or incurring an obligation for the556
643		-	expenditure of funds to develop certificate of need applications, studies, reports,557
644		-	schematics, preliminary plans and specifications or working drawings, or to acquire sites;558
645		-	(19) Any joint venture ambulatory surgical center that:559
646		-	(A) Has capital expenditures associated with the construction, development, or other560
647		-	establishment of the clinical health service which do not exceed $5 million;561
648		-	(B)(i) Provides care to Medicaid beneficiaries and, if the facility provides medical562
649		-	care and treatment to children, to PeachCare for Kids beneficiaries and provides563
650		-	uncompensated indigent and charity care in an amount equal to or greater than 2564
651		-	percent of its adjusted gross revenue, and on and after January 1, 2026, in an amount
652		-	565
653		-	equal to or greater than the minimum amount established by the department which566
654		-	shall be reviewed by the department every 12 months; or567
655		-	(ii) If the center is not a participant in Medicaid or the PeachCare for Kids Program,568
656		-	provides uncompensated care to Medicaid beneficiaries and, if the facility provides569
657		-	medical care and treatment to children, to PeachCare for Kids beneficiaries,570
658		-	uncompensated indigent and charity care, or both in an amount equal to or greater571
659		-	than 4 percent of its adjusted gross revenue, and on and after January 1, 2026, in an572
660		-	H. B. 1339
661		-	- 22 - 24 HB 1339/AP
662		-	amount equal to or greater than the minimum amount established by the department573
663		-	which shall be reviewed by the department every 12 months; and574
664		-	(C) Provides annual reports in the same manner and in accordance with Code Section575
665		-	31-6-70.576
666		-	Noncompliance with any condition of this paragraph shall result in a monetary penalty577
667		-	in the amount of the difference between the services which the center is required to578
668		-	provide and the amount actually provided and may be subject to revocation of its579
669		-	exemption status by the department for repeated failure to pay any fines or moneys due580
670		-	to the department or for repeated failure to produce data as required by Code581
671		-	Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to582
672		-	Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.' The dollar amount583
673		-	specified in this paragraph shall be adjusted annually by an amount calculated by584
674		-	multiplying such dollar amount (as adjusted for the preceding year) by the annual585
675		-	percentage of change in the composite index of construction material prices, or its586
676		-	successor or appropriate replacement index, if any, published by the United States587
677		-	Department of Commerce for the preceding calendar year, commencing on July 1, 2009,588
678		-	and on each anniversary thereafter of publication of the index. The department shall589
679		-	immediately institute rule-making procedures to adopt such adjusted dollar amounts. In590
680		-	calculating the dollar amounts of a proposed project for purposes of this paragraph, the591
681		-	costs of all items subject to review by this chapter and items not subject to review by this592
682		-	chapter associated with and simultaneously developed or proposed with the project shall593
683		-	be counted, except for the expenditure or commitment of or incurring an obligation for594
684		-	the expenditure of funds to develop certificate of need applications, studies, reports,595
685		-	schematics, preliminary plans and specifications or working drawings, or to acquire sites;596
686		-	(20) Expansion of services by an imaging center based on a population needs597
687		-	methodology taking into consideration whether the population residing in the area served598
688		-	H. B. 1339
689		-	- 23 - 24 HB 1339/AP
690		-	by the imaging center has a need for expanded services, as determined by the department
691		-	599
692		-	in accordance with its rules and regulations, if such imaging center:600
693		-	(A) Was in existence and operational in this state on January 1, 2008;601
694		-	(B) Is owned by a hospital or by a physician or a group of physicians comprising at602
695		-	least 80 percent ownership who are currently board certified in radiology;603
696		-	(C) Provides three or more diagnostic and other imaging services;604
697		-	(D) Accepts all patients regardless of ability to pay; and605
698		-	(E) Provides uncompensated indigent and charity care in an amount equal to or greater606
699		-	than the amount of such care provided by the geographically closest general acute care607
700		-	hospital; provided, however, that this paragraph shall not apply to an imaging center in608
701		-	a rural county;609
702		-	(21) Diagnostic cardiac catheterization in a hospital setting on patients 15 years of age610
703		-	and older;611
704		-	(22) Therapeutic cardiac catheterization in hospitals selected by the department prior to612
705		-	July 1, 2008, to participate in the Atlantic Cardiovascular Patient Outcomes Research613
706		-	Team (C-PORT) Study and therapeutic cardiac catheterization in hospitals that, as614
707		-	determined by the department on an annual basis, meet the criteria to participate in the615
708		-	C-PORT Study but have not been selected for participation; provided, however, that if616
709		-	the criteria requires a transfer agreement to
710		-	with another hospital, no hospital shall617
711		-	unreasonably deny a transfer agreement to with another hospital;618
712		-	(23) Infirmaries or facilities operated by, on behalf of, or under contract with the619
713		-	Department of Corrections or the Department of Juvenile Justice for the sole and620
714		-	exclusive purpose of providing health care services in a secure environment to prisoners621
715		-	within a penal institution, penitentiary, prison, detention center, or other secure622
716		-	correctional institution, including correctional institutions operated by private entities in623
717		-	this state which house inmates under the Department of Corrections or the Department624
718		-	of Juvenile Justice;625
719		-	H. B. 1339
720		-	- 24 - 24 HB 1339/AP
721		-	(24) The relocation of any skilled nursing facility, intermediate care facility, or
722		-	626
723		-	micro-hospital within the same county, any other health care facility in a rural county627
724		-	within the same county, and any other health care facility in an urban county within a628
725		-	three-mile
726		-	five-mile radius of the existing facility so long as the facility does not propose629
727		-	to offer any new or expanded clinical health services at the new location;630
728		-	(25) Facilities which are devoted to the provision of treatment and rehabilitative care for631
729		-	periods continuing for 24 hours or longer for persons who have traumatic brain injury,632
730		-	as defined in Code Section 37-3-1;633
731		-	(26) Capital expenditures for a project otherwise requiring a certificate of need if those634
732		-	expenditures are for a project to remodel, renovate, replace, or any combination thereof,635
733		-	a medical-surgical hospital and:636
734		-	(A) That hospital:637
735		-	(i) Has a bed capacity of not more than 50 beds;638
736		-	(ii) Is located in a county in which no other medical-surgical hospital is located;639
737		-	(iii) Has at any time been designated as a disproportionate share hospital by the640
738		-	department; and641
739		-	(iv) Has at least 45 percent of its patient revenues derived from medicare, Medicaid,642
740		-	or any combination thereof, for the immediately preceding three years; and643
741		-	(B) That project:644
742		-	(i) Does not result in any of the following:645
743		-	(I) The offering of any new clinical health services;646
744		-	(II) Any increase in bed capacity;647
745		-	(III) Any redistribution of existing beds among existing clinical health services; or648
746		-	(IV) Any increase in capacity of existing clinical health services;649
747		-	(ii) Has at least 80 percent of its capital expenditures financed by the proceeds of a650
748		-	special purpose county sales and use tax imposed pursuant to Article 3 of Chapter 8651
749		-	of Title 48; and652
750		-	H. B. 1339
751		-	- 25 - 24 HB 1339/AP
752		-	(iii) Is located within a three-mile five-mile radius of and within the same county as653
753		-	the hospital's existing facility;654
754		-	(27) The renovation, remodeling, refurbishment, or upgrading of a health care facility,655
755		-	so long as the project does not result in any of the following:656
756		-	(A) The offering of any new or expanded clinical health services;657
757		-	(B) Any increase in inpatient bed capacity; or658
758		-	(C) Any redistribution of existing beds among existing clinical health services; or659
759		-	(D) A capital expenditure exceeding the threshold contained in paragraph (2) of660
760		-	subsection (a) of Code Section 31-6-40;661
761		-	(28) Other than for equipment used to provide positron emission tomography (PET)662
762		-	services, the The acquisition of diagnostic, therapeutic, or other imaging equipment with663
763		-	a value of $3 million or less, by or on behalf of:664
764		-	(A) A hospital; or665
765		-	(B) An individual private physician or single group practice of physicians exclusively666
766		-	for use on patients of such private physician or single group practice of physicians and667
767		-	such private physician or member of such single group practice of physicians is668
768		-	physically present at the practice location where the diagnostic or other imaging669
769		-	equipment is located at least 75 percent of the time that the equipment is in use.;670
770		-	The amount specified in this paragraph shall not include build-out costs, as defined by671
771		-	the department, but shall include all functionally related equipment, software, and any672
772		-	warranty and services contract costs for the first five years. The acquisition of one or673
773		-	more items of functionally related diagnostic or therapeutic equipment shall be674
774		-	considered as one project. The dollar amount specified in this paragraph and in675
775		-	paragraph (10) of this subsection shall be adjusted annually by an amount calculated by676
776		-	multiplying such dollar amounts (as adjusted for the preceding year) by the annual677
777		-	percentage of change in the consumer price index, or its successor or appropriate678
778		-	H. B. 1339
779		-	- 26 - 24 HB 1339/AP
780		-	replacement index, if any, published by the United States Department of Labor for the679
781		-	preceding calendar year, commencing on July 1, 2010; and680
782		-	(29) Any capital expenditures A capital expenditure of $10 million or less by a hospital681
783		-	at such hospital's primary campus for:682
784		-	(A) The expansion or addition of the following clinical health services: operating683
785		-	rooms, other than dedicated outpatient operating rooms; medical-surgical services;684
786		-	gynecology; procedure rooms; intensive care; pharmaceutical services; pediatrics;685
787		-	cardiac care or other general hospital services; provided, however, that such686
788		-	expenditure does not include the expansion or addition of inpatient beds or the687
789		-	conversion of one type of inpatient bed to another type of inpatient bed; or688
790		-	(B) The movement of clinical health services from one location on the hospital's689
791		-	primary campus to another location on such hospital's primary campus;690
792		-	(30) New or expanded psychiatric or substance abuse inpatient programs or state funded691
793		-	beds that serve Medicaid and uninsured patients that:692
794		-	(A) Are open 365 days per year, seven days per week, and 24 hours per day;693
795		-	(B) Provide uncompensated indigent and charity care in an amount equal to or greater694
796		-	than 3 percent of its adjusted gross revenue, and on and after January 1, 2026, in an695
797		-	amount equal to or greater than the minimum amount established by the department by696
798		-	rule which shall be at least 3 percent and which shall be reviewed by the department697
799		-	every 12 months;698
800		-	(C) Participate as providers of medical assistance for Medicaid purposes;699
801		-	(D) Have hospital affiliation agreements with acute care hospitals within a reasonable700
802		-	distance from the programs or state funded beds or the medical staffs at the programs701
803		-	or state funded beds have admitting privileges or other acceptable documented702
804		-	arrangements with such hospitals to ensure the necessary backup for the programs or703
805		-	state funded beds for medical complications. The programs or state funded beds shall704
806		-	have the capability to transfer a patient immediately to a hospital within a reasonable705
807		-	H. B. 1339
808		-	- 27 - 24 HB 1339/AP
809		-	distance from the programs or state funded beds with adequate emergency room706
810		-	services. Acute care hospitals shall not unreasonably deny a transfer agreement or707
811		-	affiliation agreement with the programs or state funded beds; and708
812		-	(E) Provide annual reports in the same manner and in accordance with Code Section709
813		-	31-6-70;710
814		-	(31) The offering of new or expanded basic perinatal services by a hospital in a rural711
815		-	county provided that:712
816		-	(A) Such services are available 365 days per year, seven days per week, and 24 hours713
817		-	per day;714
818		-	(B) The hospital participates as a provider of medical assistance for Medicaid715
819		-	purposes;716
820		-	(C) The hospital has a hospital affiliation agreement with an acute care hospital with717
821		-	at least Level III perinatal services within a reasonable distance from the hospital718
822		-	providing the perinatal services or the medical staff at the hospital providing the719
823		-	perinatal services has admitting privileges or other acceptable documented720
824		-	arrangements with such acute care hospital to ensure the necessary backup for the721
825		-	hospital providing the perinatal services for medical complications. The hospital722
826		-	providing the perinatal services shall have the capability to transfer a patient723
827		-	immediately to the acute care hospital within a reasonable distance from the hospital724
828		-	providing the perinatal services with adequate emergency room services. Acute care725
829		-	hospitals shall not unreasonably deny a transfer agreement or affiliation agreement with726
830		-	the hospital providing the perinatal services. This subparagraph shall not apply if the727
831		-	hospital providing the basic perinatal services is itself an acute care hospital with at728
832		-	least Level III perinatal services; and729
833		-	(D) Provides annual reports in the same manner and in accordance with Code Section730
834		-	31-6-70;731
835		-	H. B. 1339
836		-	- 28 - 24 HB 1339/AP
837		-	(31.1) Any new or expanded building or facility where human births occur on a regular732
838		-	and ongoing basis and which is classified as a birthing center by the department for733
839		-	purposes of Chapter 7 of this title, provided that:734
840		-	(A) Services are available 365 days per year, seven days per week, and 24 hours per735
841		-	day;736
842		-	(B) The birthing center participates as a provider of medical assistance for Medicaid737
843		-	purposes;738
844		-	(C) The birthing center has a hospital affiliation agreement with an acute care hospital739
845		-	with at least Level III perinatal services within a reasonable distance from the birthing740
846		-	center or the medical staff at the birthing center has admitting privileges or other741
847		-	acceptable documented arrangements with such acute care hospital to ensure the742
848		-	necessary backup for the birthing center for medical complications. The birthing center743
849		-	shall have the capability to transfer a patient immediately to the acute care hospital744
850		-	within a reasonable distance from the birthing center. Acute care hospitals shall not745
851		-	unreasonably deny a transfer agreement or affiliation agreement with the birthing746
852		-	center;747
853		-	(D) The birthing center:748
854		-	(i) Provides basic perinatal services, as defined by the department, which shall749
855		-	include but not be limited to a combination of such services as determined by the750
856		-	department;751
857		-	(ii) Meets the standards for certification established by the American Association of752
858		-	Birth Centers, or equivalent or higher standards as determined by the department;753
859		-	(iii) Schedules routine visits and visits with other appropriate providers, as necessary,754
860		-	and tracks patients to verify that services have been received;755
861		-	(iv) Prior to 20 weeks gestation, certifies that a patient has been deemed to be a low756
862		-	risk patient, as defined by the department for purposes of this paragraph;757
863		-	(v) Admits and provides services only to patients certified as low risk; and758
864		-	H. B. 1339
865		-	- 29 - 24 HB 1339/AP
866		-	(vi) Refers patients to other appropriate providers if, at any point between the 20759
867		-	weeks gestation certification and antepartum, the birthing center determines that a760
868		-	patient no longer qualifies as a low risk patient for any reason; and761
869		-	(E) The birthing center provides annual reports in the same manner and in accordance762
870		-	with Code Section 31-6-70;763
871		-	(32) A new general acute care hospital in a rural county that:764
872		-	(A)(i) Attains status as a teaching hospital within 36 months of opening, and765
873		-	maintains such status thereafter; or766
874		-	(ii) Obtains verification as a Level I, II, III, or IV trauma center from the American767
875		-	College of Surgeons within 36 months of opening, and maintains such verification768
876		-	thereafter;769
877		-	(B) Provides emergency, inpatient, and outpatient psychiatric and behavioral health770
878		-	services;771
879		-	(C) Has an emergency department that is open 365 days per year, seven days per week,772
880		-	and 24 hours per day;773
881		-	(D) Provides uncompensated indigent and charity care in an amount equal to or greater774
882		-	than 3 percent of its adjusted gross revenue, and on and after January 1, 2026, in an775
883		-	amount equal to or greater than the minimum amount established by the department by776
884		-	rule which shall be no less than 3 percent and which shall be reviewed by the777
885		-	department every 12 months;778
886		-	(E) Participates as a provider of medical assistance for Medicaid purposes; and779
887		-	(F) Provides annual reports in the same manner and in accordance with Code Section780
888		-	31-6-70;781
889		-	(33) A new acute care hospital where a short-stay general hospital in a rural county has782
890		-	been closed for more than 12 months and a new replacement hospital has not opened that:783
891		-	(A) Is located in the same rural county where the short-stay general hospital was784
892		-	closed;785
893		-	H. B. 1339
894		-	- 30 - 24 HB 1339/AP
895		-	(B) Has no more than the number of licensed beds that were previously licensed in the786
896		-	closed hospital;787
897		-	(C) Has an emergency department that is open 365 days per year, seven days per week,788
898		-	and 24 hours per day;789
	30	+	paragraphs (15), (17), (23), and (33) of Code Section 31-6-2, relating to definitions relative24
	31	+	to state health planning and development, as follows:25
	32	+	"(15) 'Diagnostic imaging' means magnetic resonance imaging, computed tomography26
	33	+	(CT) scanning, positron emission tomography (PET) scanning, positron emission27
	34	+	tomography/computed tomography, X-rays, fluoroscopy, ultrasound services, and any28
	35	+	other advanced imaging services as defined by the department by rule, but such term shall29
	36	+	not include X-rays, fluoroscopy, or ultrasound services."30
	37	+	"(17) 'Health care facility' means hospitals; destination cancer hospitals; other special31
	38	+	care units, including, but not limited to, podiatric facilities; skilled nursing facilities;32
	39	+	intermediate care facilities; personal care homes; ambulatory surgical centers or33
	40	+	obstetrical facilities; freestanding emergency departments or facilities not located on a34
	41	+	hospital's primary campus; health maintenance organizations; home health agencies; and35
	42	+	diagnostic, treatment, or rehabilitation centers, but only to the extent paragraph (3) or (7),36
	43	+	or both paragraphs (3) and (7), of subsection (a) of Code Section 31-6-40 are is applicable37
	44	+	thereto."38
	45	+	"(23) 'Joint venture ambulatory surgical center' means a freestanding ambulatory surgical39
	46	+	center that is jointly owned by a hospital in the same county as the center or a hospital in40
	47	+	a contiguous county if there is no hospital in the same county as the center and a single41
	48	+	group of physicians practicing in the center and that provides surgery in a single specialty42
	49	+	as defined by the department; provided, however, that any such single group of43
	50	+	- 2 - 24 LC 33 9707S
	51	+	physicians may simultaneously be members of a group practice of physicians which44
	52	+	includes additional physicians in the same or different specialties so long as such other45
	53	+	group practice does not have any other single group of physicians that owns, operates, or46
	54	+	utilizes another ambulatory surgical center in a specialty different than the joint venture47
	55	+	ambulatory surgical center. General general surgery,; cardiology, including, but not48
	56	+	limited to, cardiac catheterization; vascular surgery and interventional radiologists; a49
	57	+	group practice which includes one or more physiatrists who perform services that are50
	58	+	reasonably related to the surgical procedures performed in the center,; and a group51
	59	+	practice in orthopedics which includes plastic hand surgeons with a certificate of added52
	60	+	qualifications in Surgery of the Hand from the American Board of Plastic and53
	61	+	Reconstructive Surgery shall be considered a single specialty. The ownership interest of54
	62	+	the hospital shall be no less than 30 percent and the collective ownership of the55
	63	+	physicians or group practice of physicians shall be no less than 30 percent. The56
	64	+	physicians or group practice of physicians may operate and manage the practice57
	65	+	themselves or have a management contract or other arrangement with an entity that58
	66	+	provides management services, administrative services, or both."59
	67	+	"(33) 'Single specialty ambulatory surgical center' means an ambulatory surgical center60
	68	+	where surgery is performed in the offices of an individual private physician, or a single61
	69	+	group practice of private physicians, or a single group of physicians that is62
	70	+	simultaneously members of a group practice of physicians which includes additional63
	71	+	physicians in the same or different specialties so long as such other group practice does64
	72	+	not have any other single group of physicians that owns, operates, or utilizes another65
	73	+	ambulatory surgical center in a specialty different than the single specialty ambulatory66
	74	+	surgical center, if such surgery is performed in a facility that is owned, operated, and67
	75	+	utilized by such individual physician, single group practice of physicians, or single group68
	76	+	of physicians who also are of a single specialty.; provided, however, that general General69
	77	+	surgery,; cardiology, including, but not limited to, cardiac catheterization; vascular70
	78	+	- 3 - 24 LC 33 9707S
	79	+	surgery and interventional radiologists; a group practice which includes one or more71
	80	+	physiatrists who perform services that are reasonably related to the surgical procedures72
	81	+	performed in the center,; and a group practice in orthopedics which includes plastic hand73
	82	+	surgeons with a certificate of added qualifications in Surgery of the Hand from the74
	83	+	American Board of Plastic and Reconstructive Surgery shall be considered a single75
	84	+	specialty. The collective ownership of the physicians or group practice of physicians76
	85	+	shall be no less than 30 percent. Each physician practice or group physician practice or77
	86	+	practices may manage their respective practices themselves or have a management78
	87	+	contract or other arrangement with an entity that provides management services,79
	88	+	administrative services, or both."80
	89	+	SECTION 2.81
	90	+	Said title is further amended in Code Section 31-6-21, relating to Department of Community82
	91	+	Health functions and powers with respect to state health planning and development, by83
	92	+	revising subsection (a) as follows:84
	93	+	"(a) The Department of Community Health, established under Chapter 2 of this title, is85
	94	+	authorized to administer the certificate of need program established under this chapter and,86
	95	+	within the appropriations made available to the department by the General Assembly of87
	96	+	Georgia and consistently with the laws of the State of Georgia, a state health plan adopted88
	97	+	by the board. The department shall review and update the state health plan at least every89
	98	+	five years beginning no later than January 1, 2025, to ensure the plan meets the evolving90
	99	+	needs of the state. The department shall provide, by rule, for procedures to administer its91
	100	+	functions until otherwise provided by the board."92
	101	+	- 4 - 24 LC 33 9707S
	102	+	SECTION 3.93
	103	+	Said title is further amended in Code Section 31-6-40, relating to certificate of need required94
	104	+	for new institutional health services and exemption, by revising subsections (a), (b), and (c)95
	105	+	as follows:96
	106	+	"(a) On and after July 1, 2008, any new institutional health service shall be required to97
	107	+	obtain a certificate of need pursuant to this chapter. New institutional health services98
	108	+	include:99
	109	+	(1) The construction, development, or other establishment of a new, expanded, or100
	110	+	relocated health care facility, except as otherwise provided in Code Section 31-6-47;101
	111	+	(2) Any expenditure by or on behalf of a health care facility in excess of $10 million102
	112	+	which, under generally accepted accounting principles consistently applied, is a capital103
	113	+	expenditure, except expenditures for acquisition of an existing health care facility. The104
	114	+	dollar amounts specified in this paragraph and in paragraph (14) of Code Section 31-6-2105
	115	+	shall be adjusted annually by an amount calculated by multiplying such dollar amounts106
	116	+	(as adjusted for the preceding year) by the annual percentage of change in the composite107
	117	+	index of construction material prices, or its successor or appropriate replacement index,108
	118	+	if any, published by the United States Department of Commerce for the preceding109
	119	+	calendar year, commencing on July 1, 2019, and on each anniversary thereafter of110
	120	+	publication of the index. The department shall immediately institute rule-making111
	121	+	procedures to adopt such adjusted dollar amounts. In calculating the dollar amounts of112
	122	+	a proposed project for purposes of this paragraph and paragraph (14) of Code Section113
	123	+	31-6-2, the costs of all items subject to review by this chapter and items not subject to114
	124	+	review by this chapter associated with and simultaneously developed or proposed with115
	125	+	the project shall be counted, except for the expenditure or commitment of or incurring an116
	126	+	obligation for the expenditure of funds to develop certificate of need applications, studies,117
	127	+	reports, schematics, preliminary plans and specifications or working drawings, or to118
	128	+	acquire sites; Reserved;119
	129	+	- 5 - 24 LC 33 9707S
	130	+	(3) The purchase or lease by or on behalf of a health care facility or a diagnostic,120
	131	+	treatment, or rehabilitation center of diagnostic or therapeutic equipment, except as121
	132	+	otherwise provided in Code Section 31-6-47; Reserved.122
	133	+	(4) Any increase in the bed capacity of a health care facility except as provided in Code123
	134	+	Section 31-6-47;124
	135	+	(5) Clinical health services which are offered in or through a health care facility, which125
	136	+	were not offered on a regular basis in or through such health care facility within the 12126
	137	+	month period prior to the time such services would be offered;127
	138	+	(6) Any conversion or upgrading of any general acute care hospital to a specialty hospital128
	139	+	or of a facility such that it is converted from a type of facility not covered by this chapter129
	140	+	to any of the types of health care facilities which are covered by this chapter;130
	141	+	(7) Clinical health services which are offered in or through a diagnostic, treatment, or131
	142	+	rehabilitation center which were not offered on a regular basis in or through that center132
	143	+	within the 12 month period prior to the time such services would be offered, but only if133
	144	+	the clinical health services are any of the following:134
	145	+	(A) Radiation therapy;135
	146	+	(B) Biliary lithotripsy;136
	147	+	(C) Surgery in an operating room environment, including, but not limited to,137
	148	+	ambulatory surgery; and138
	149	+	(D) Cardiac catheterization; and139
	150	+	(8) The conversion of a destination cancer hospital to a general cancer hospital.140
	151	+	(b) Any person proposing to develop or offer a new institutional health service or health141
	152	+	care facility shall, before commencing such activity, submit a letter of intent and an142
	153	+	application to the department and obtain a certificate of need in the manner provided in this143
	154	+	chapter unless such activity is excluded from the scope of this chapter.144
	155	+	- 6 - 24 LC 33 9707S
	156	+	(c)(1) Any person who had a valid exemption granted or approved by the former Health145
	157	+	Planning Agency or the department prior to July 1, 2008, shall not be required to obtain146
	158	+	a certificate of need in order to continue to offer those previously offered services.147
	159	+	(2) Any facility offering ambulatory surgery pursuant to the exclusion designated on148
	160	+	June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2; any diagnostic, treatment,149
	161	+	or rehabilitation center offering diagnostic imaging or other imaging services in operation150
	162	+	and exempt prior to July 1, 2008; or any facility operating pursuant to a letter of151
	163	+	nonreviewability and offering diagnostic imaging services prior to July 1, 2008, shall:152
	164	+	(A) Provide annual reports in the same manner and in accordance with Code Section153
	165	+	31-6-70; and154
	166	+	(B)(i) Provide care to Medicaid beneficiaries and, if the facility provides medical care155
	167	+	and treatment to children, to PeachCare for Kids beneficiaries and provide156
	168	+	uncompensated indigent and charity care in an amount equal to or greater than 2157
	169	+	percent of its adjusted gross revenue; or158
	170	+	(ii) If the facility is not a participant in Medicaid or the PeachCare for Kids Program,159
	171	+	provide uncompensated care for Medicaid beneficiaries and, if the facility provides160
	172	+	medical care and treatment to children, for PeachCare for Kids beneficiaries,161
	173	+	uncompensated indigent and charity care, or both in an amount equal to or greater162
	174	+	than 4 percent of its adjusted gross revenue if it:163
	175	+	(I) Makes a capital expenditure associated with the construction, development,164
	176	+	expansion, or other establishment of a clinical health service or the acquisition or165
	177	+	replacement of diagnostic or therapeutic equipment with a value in excess of166
	178	+	$800,000.00 over a two-year period;167
	179	+	(II) Builds a new operating room; or168
	180	+	(III) Chooses to relocate in accordance with Code Section 31-6-47.169
	181	+	Noncompliance with any condition of this paragraph shall result in a monetary penalty170
	182	+	in the amount of the difference between the services which the center is required to171
	183	+	- 7 - 24 LC 33 9707S
	184	+	provide and the amount actually provided and may be subject to revocation of its172
	185	+	exemption status by the department for repeated failure to pay any fees or moneys due173
	186	+	to the department or for repeated failure to produce data as required by Code Section174
	187	+	31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of175
	188	+	Title 50, the 'Georgia Administrative Procedure Act.' The dollar amount specified in this176
	189	+	paragraph shall be adjusted annually by an amount calculated by multiplying such dollar177
	190	+	amount (as adjusted for the preceding year) by the annual percentage of change in the178
	191	+	consumer price index, or its successor or appropriate replacement index, if any, published179
	192	+	by the United States Department of Labor for the preceding calendar year, commencing180
	193	+	on July 1, 2009. In calculating the dollar amounts of a proposed project for the purposes181
	194	+	of this paragraph, the costs of all items subject to review by this chapter and items not182
	195	+	subject to review by this chapter associated with and simultaneously developed or183
	196	+	proposed with the project shall be counted, except for the expenditure or commitment of184
	197	+	or incurring an obligation for the expenditure of funds to develop certificate of need185
	198	+	applications, studies, reports, schematics, preliminary plans and specifications or working186
	199	+	drawings, or to acquire sites. Subparagraph (B) of this paragraph shall not apply to187
	200	+	facilities offering ophthalmic ambulatory surgery pursuant to the exclusion designated188
	201	+	on June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2 that are owned by189
	202	+	physicians in the practice of ophthalmology."190
	203	+	SECTION 4.191
	204	+	Said title is further amended by revising Code Section 31-6-43, relating to acceptance or192
	205	+	rejection of application for certificate, as follows:193
	206	+	- 8 - 24 LC 33 9707S
	207	+	"31-6-43.194
	208	+	(a) At least 30 25 days prior to submitting an application for a certificate of need for195
	209	+	clinical health services, a person shall submit a letter of intent to the department. The196
	210	+	department shall provide by rule a process for submitting letters of intent and a mechanism197
	211	+	by which applications may be filed to compete with and be reviewed comparatively with198
	212	+	proposals described in submitted letters of intent.199
	213	+	(b) Each application for a certificate of need shall be reviewed received by the department,200
	214	+	and within ten working days after the date of its receipt a determination shall be made as201
	215	+	to whether the application complies with the rules governing the preparation and202
	216	+	submission of applications. If the application complies with the rules governing the203
	217	+	preparation and submission of applications, and the department shall declare the204
	218	+	application complete for review, shall accept and date the application, and shall notify the205
	219	+	applicant of the timetable for its review. The department shall also notify a newspaper of206
	220	+	general circulation in the county in which the project shall be developed that the207
	221	+	application has been deemed complete. The department shall also notify the appropriate208
	222	+	regional commission and the chief elected official of the county and municipal209
	223	+	governments, if any, in whose boundaries the proposed project will be located that the210
	224	+	application is complete for review. If the application does not comply with the rules211
	225	+	governing the preparation and submission of applications, the department shall notify the212
	226	+	applicant in writing and provide a list of all deficiencies. The applicant shall be afforded213
	227	+	an opportunity to correct such deficiencies, and upon such correction, the application shall214
	228	+	then be declared complete for review within ten days of the correction of such deficiencies,215
	229	+	and notice given to a newspaper of general circulation in the county in which the project216
	230	+	shall be developed that the application has been so declared. The department shall also217
	231	+	notify the appropriate regional commission and the chief elected official of the county and218
	232	+	municipal governments, if any, in whose boundaries the proposed project will be located219
	233	+	- 9 - 24 LC 33 9707S
	234	+	that the application is complete for review or when in the determination of the department220
	235	+	a significant amendment is filed.221
	236	+	(c) The department shall specify by rule the time within which an applicant may amend222
	237	+	its application. The department may request an applicant to make amendments. The223
	238	+	department decision shall be made on an application as amended, if at all, by the applicant.224
	239	+	(d)(1) There shall be a time limit of 120 days for review of a project, beginning on the225
	240	+	day the department declares the application complete for review or in the case of226
	241	+	applications joined for comparative review, beginning on the day the department declares227
	242	+	the final application complete receives the application. The department may adopt rules228
	243	+	for determining when it is not practicable to complete a review in 120 days and may229
	244	+	extend the review period upon written notice to the applicant but only for an extended230
	245	+	period of not longer than an additional 30 days. The department shall adopt rules231
	246	+	governing the submission of additional information by the applicant and for opposing an232
	247	+	application; provided, however, that such rules shall provide that any party permitted to233
	248	+	oppose an application shall submit a notice of opposition no later than 30 days of receipt234
	249	+	by the department of such application.235
	250	+	(2) No party may oppose an application for a certificate of need for a proposed project236
	251	+	unless:237
	252	+	(A) Such party offers substantially similar services as proposed within a 35 mile radius238
	253	+	of the proposed project or has a service area that overlaps the applicant's proposed239
	254	+	service area; or240
	255	+	(B) Such party has submitted a competing application in the same batching cycle and241
	256	+	is proposing to establish the same type of facility proposed or offers substantially242
	257	+	similar services as proposed and has a service area that overlaps the applicant's243
	258	+	proposed service area.244
	259	+	(e) To allow the opportunity for comparative review of applications, the department may245
	260	+	provide by rule for applications for a certificate of need to be submitted on a timetable or246
	261	+	- 10 - 24 LC 33 9707S
	262	+	batching cycle basis no less often than two times per calendar year for each clinical health247
	263	+	service. Applications for services, facilities, or expenditures for which there is no specified248
	264	+	batching cycle may be filed at any time.249
	265	+	(f) The department may order the joinder of an application which is determined to be250
	266	+	complete by the department for comparative review with one or more subsequently filed251
	267	+	applications declared complete for review during the same batching cycle when:252
	268	+	(1) The first and subsequent applications involve similar clinical health service projects253
	269	+	in the same service area or overlapping service areas; and254
	270	+	(2) The subsequent applications are filed and are declared complete for review within 30255
	271	+	days of the date the first application was declared complete for review.256
	272	+	Following joinder of the first application with subsequent applications, none of the257
	273	+	subsequent applications so joined may be considered as a first application for the purposes258
	274	+	of future joinder. The department shall notify the applicant to whose application a joinder259
	275	+	is ordered and all other applicants previously joined to such application of the fact of each260
	276	+	joinder pursuant to this subsection. In the event one or more applications have been joined261
	277	+	pursuant to this subsection, the time limits for department action for all of the applicants262
	278	+	shall run from the latest date that any one of the joined applications was declared complete263
	279	+	for review. In the event of the consideration of one or more applications joined pursuant264
	280	+	to this subsection, the department may award no certificate of need or one or more265
	281	+	certificates of need to the application or applications, if any, which are consistent with the266
	282	+	considerations contained in Code Section 31-6-42, the department's applicable rules, and267
	283	+	the award of which will best satisfy the purposes of this chapter.268
	284	+	(g) The department shall review the application and all written information submitted by269
	285	+	the applicant in support of the application and all information submitted in opposition to270
	286	+	the application to determine the extent to which the proposed project is consistent with the271
	287	+	applicable considerations stated in Code Section 31-6-42 and in the department's applicable272
	288	+	rules. During the course of the review, the department staff may request additional273
	289	+	- 11 - 24 LC 33 9707S
	290	+	information from the applicant as deemed appropriate. Pursuant to rules adopted by the274
	291	+	department, a public hearing on applications covered by those regulations may be held275
	292	+	prior to the date of the department's decision thereon. Such rules shall provide that when276
	293	+	good cause has been shown, a public hearing shall be held by the department. Any277
	294	+	interested person may submit information to the department concerning an application, and278
	295	+	an applicant shall be entitled to notice of and to respond to any such submission.279
	296	+	(h) The department shall within 30 days of receipt of the application provide the applicant280
	297	+	an opportunity to meet with the department to discuss the such application and to provide281
	298	+	the applicant an opportunity to submit additional information. Such additional information282
	299	+	shall be submitted within the time limits adopted by the department. The department shall283
	300	+	also provide an opportunity for any party that is permitted to oppose an application284
	301	+	pursuant to paragraph (2) of subsection (d) of this Code section to meet with the285
	302	+	department and to provide additional information to the department. In order for any such286
	303	+	opposing party to have standing to appeal an adverse decision pursuant to Code Section287
	304	+	31-6-44, such party must attend and participate in an opposition meeting.288
	305	+	(i) Unless extended by the department for an additional period of up to 30 days pursuant289
	306	+	to subsection (d) of this Code section, the department shall, no later than 120 days after an290
	307	+	application is determined to be complete for review, or, in the event of joined applications,291
	308	+	120 days after the last application is declared complete for review, provide written292
	309	+	notification to an applicant of the department's decision to issue or to deny issuance of a293
	310	+	certificate of need for the proposed project. Such notice shall contain the department's294
	311	+	written findings of fact and decision as to each applicable consideration or rule and a295
	312	+	detailed statement of the reasons and evidentiary support for issuing or denying a certificate296
	313	+	of need for the action proposed by each applicant. The department shall also mail such297
	314	+	notification to the appropriate regional commission and the chief elected official of the298
	315	+	county and municipal governments, if any, in whose boundaries the proposed project will299
	316	+	be located. In the event such decision is to issue a certificate of need, the certificate of300
	317	+	- 12 - 24 LC 33 9707S
	318	+	need shall be effective on the day of the decision unless the decision is appealed to the301
	319	+	Certificate of Need Appeal Panel in accordance with this chapter. Within seven days of302
	320	+	the decision, the department shall publish notice of its decision to grant or deny an303
	321	+	application in the same manner as it publishes notice of the filing of an application.304
	322	+	(j) Should the department fail to provide written notification of the decision within the305
	323	+	time limitations set forth in this Code section, an application shall be deemed to have been306
	324	+	approved as of the one hundred twenty-first day following notice from the department that307
	325	+	an application, or the last of any applications joined pursuant to subsection (f) of this Code308
	326	+	section, is declared 'complete for review.'309
	327	+	(k) Notwithstanding other provisions of this article, when the Governor has declared a310
	328	+	state of emergency in a region of the state, existing health care facilities in the affected311
	329	+	region may seek emergency approval from the department to make expenditures in excess312
	330	+	of the capital expenditure threshold or to offer services that may otherwise require a313
	331	+	certificate of need. The department shall give special expedited consideration to such314
	332	+	requests and may authorize such requests for good cause. Once the state of emergency has315
	333	+	been lifted, any services offered by an affected health care facility under this subsection316
	334	+	shall cease to be offered until such time as the health care facility that received the317
	335	+	emergency authorization has requested and received a certificate of need. For purposes of318
	336	+	this subsection, the term 'good cause' means that authorization of the request shall directly319
	337	+	resolve a situation posing an immediate threat to the health and safety of the public. The320
	338	+	department shall establish, by rule, procedures whereby requirements for the process of321
	339	+	review and issuance of a certificate of need may be modified and expedited as a result of322
	340	+	emergency situations."323
	341	+	SECTION 5.324
	342	+	Said title is further amended by revising subsections (i), (j), (k), and (l) of Code325
	343	+	Section 31-6-44, relating to the Certificate of Need Appeal Panel, as follows:326
	344	+	- 13 - 24 LC 33 9707S
	345	+	"(i)(1) Within 30 days after the conclusion of the hearing, the hearing officer shall make327
	346	+	written findings of fact and conclusions of law as to each consideration as set forth in328
	347	+	Code Section 31-6-42 and the department's rules, including a detailed statement of the329
	348	+	reasons for the decision of the hearing officer, which shall be deemed the final decision330
	349	+	of the appeal panel. If any party has alleged that an appeal lacks substantial justification331
	350	+	or was undertaken primarily for the purpose of delay or harassment, the decision of the332
	351	+	hearing officer shall make findings of fact addressing the merits of the allegation. The333
	352	+	hearing officer shall file such decision with the chairperson of the appeal panel who shall334
	353	+	serve such decision upon all parties, and shall transmit the administrative record to the335
	354	+	commissioner. 336
	355	+	(2) For hearings that are transcribed by a certified court reporter, when the transcript is337
	356	+	complete, the certified court reporter shall simultaneously and immediately notify the338
	357	+	hearing officer and all parties, including any intervenors. The hearing officer shall then339
	358	+	have 60 days to make written findings of fact and conclusions of law required by this340
	359	+	Code section. If the hearing officer fails to make a timely decision pursuant to this341
	360	+	paragraph, the department shall provide written notice of the delinquency, by statutory342
	361	+	overnight delivery or email, to the hearing officer and all parties, including intervenors. 343
	362	+	Regardless of whether the department sends the notice of delinquency, the decision made344
	363	+	pursuant to Code Section 31-6-43 shall become the final decision of the appeal panel if345
	364	+	the hearing officer does not enter findings of fact and conclusions of law within 75 days346
	365	+	of the certified court reporter's notification of the completion of the hearing transcript. 347
	366	+	In such cases, the department shall transmit the administrative record to the348
	367	+	commissioner.349
	368	+	(3) Any party, including the department and any intervenor, which disputes any finding350
	369	+	of fact or conclusion of law rendered by the hearing officer in such hearing officer's351
	370	+	decision in the appeal panel's final decision and which wishes to appeal that decision may352
	371	+	appeal to the commissioner and shall file its specific objections with the commissioner353
	372	+	- 14 - 24 LC 33 9707S
	373	+	or his or her designee within 30 days of the date of the hearing officer's decision appeal354
	374	+	panel's final decision pursuant to rules adopted by the department.355
	375	+	(j) The final decision of the appeal panel hearing officer will shall become the final356
	376	+	decision of the department upon the sixty-first day following the date of the decision unless357
	377	+	an objection thereto is filed with the commissioner within the time limit established in358
	378	+	subsection (i) of this Code section.359
	379	+	(k)(1) In the event an appeal of the hearing officer's decision final decision of the appeal360
	380	+	panel is filed, the commissioner may adopt the hearing officer's order final decision of361
	381	+	the appeal panel as the final order of the department or the commissioner may reject or362
	382	+	modify the conclusions of law over which the department has substantive jurisdiction and363
	383	+	the interpretation of administrative rules over which it has substantive jurisdiction. By364
	384	+	rejecting or modifying such conclusion of law or interpretation of administrative rule, the365
	385	+	department must state with particularity its reasons for rejecting or modifying such366
	386	+	conclusion of law or interpretation of administrative rule and must make a finding that367
	387	+	its substituted conclusion of law or interpretation of administrative rule is as or more368
	388	+	reasonable than that which was rejected or modified. Rejection For final decisions issued369
	389	+	pursuant to paragraph (2) of subsection (i) of this Code section, the rejection or370
	390	+	modification of conclusions of law may not form the basis for rejection or modification371
	391	+	of findings of fact. The commissioner may not reject or modify the findings of fact372
	392	+	unless the commissioner first determines from a review of the entire record, and states373
	393	+	with particularity in the order, that the findings of fact were not based upon any374
	394	+	competent substantial evidence, that the final decision did not consider or apply relevant375
	395	+	and material evidence or that the proceedings on which the findings were based did not376
	396	+	comply with the essential requirements of law.377
	397	+	(2) If, before the date set for the commissioner's decision, application is made to the378
	398	+	commissioner for leave to present additional evidence and it is shown to the satisfaction379
	399	+	of the commissioner that the additional evidence is material and there were good reasons380
	400	+	- 15 - 24 LC 33 9707S
	401	+	for failure to present it in the proceedings before the hearing officer, the commissioner381
	402	+	may order that the additional evidence be taken before the same hearing officer who382
	403	+	rendered the initial decision upon conditions determined by the commissioner. A final383
	404	+	decision that was approved as a matter of law pursuant to paragraph (2) of subsection (i)384
	405	+	of this Code section shall not, standing alone, be considered a good reason to warrant the385
	406	+	consideration of additional evidence. Except for final decisions resulting from operation386
	407	+	of paragraph (2) of subsection (i) of this Code section, the The hearing officer may387
	408	+	modify the initial decision by reason of the additional evidence and shall file that388
	409	+	evidence and any modifications, new findings, or decision with the commissioner. 389
	410	+	Unless leave is given by the commissioner in accordance with the provisions of this390
	411	+	subsection, the appeal panel may not consider new evidence under any circumstances. 391
	412	+	In all circumstances, the commissioner's decision shall be based upon considerations as392
	413	+	set forth in Code Section 31-6-42 and the department's rules.393
	414	+	(l) If, based upon the findings of fact by the hearing officer or in the case of a final394
	415	+	decision resulting from the operation of paragraph (2) of subsection (i) of this Code section,395
	416	+	the commissioner determines that the appeal filed by any party of a decision of the396
	417	+	department lacks substantial justification and was undertaken primarily for the purpose of397
	418	+	delay or harassment, the commissioner may enter an award in his or her written order398
	419	+	against such party and in favor of the successful party or parties, including the department,399
	420	+	of all or any part of their respective reasonable and necessary attorney's fees and expenses400
	421	+	of litigation, as the commissioner deems just. Such award may be enforced by any court401
	422	+	undertaking judicial review of the final decision. In the absence of any petition for judicial402
	423	+	review, then such award shall be enforced, upon due application, by any court having403
	424	+	personal jurisdiction over the party against whom such an award is made."404
	425	+	- 16 - 24 LC 33 9707S
	426	+	SECTION 6.405
	427	+	Said title is further amended by revising Code Section 31-6-47, relating to exemptions from406
	428	+	certificate of need requirements, as follows:407
	429	+	"31-6-47.408
	430	+	(a) Notwithstanding the other provisions of this chapter, this chapter shall not apply to:409
	431	+	(1) Infirmaries operated by educational institutions for the sole and exclusive benefit of410
	432	+	students, faculty members, officers, or employees thereof;411
	433	+	(2) Infirmaries or facilities operated by businesses for the sole and exclusive benefit of412
	434	+	officers or employees thereof, provided that such infirmaries or facilities make no413
	435	+	provision for overnight stay by persons receiving their services;414
	436	+	(3) Institutions operated exclusively by the federal government or by any of its agencies;415
	437	+	(4) Offices of private physicians or dentists whether for individual or group practice,416
	438	+	except as otherwise provided in paragraph (3) or (7) of subsection (a) of Code417
	439	+	Section 31-6-40;418
	440	+	(5) Religious, nonmedical health care institutions as defined in 42 U.S.C.419
	441	+	Section 1395x(ss)(1), listed and certified by a national accrediting organization;420
	442	+	(6) Site acquisitions for health care facilities or preparation or development costs for421
	443	+	such sites prior to the decision to file a certificate of need application;422
	444	+	(7) Expenditures related to adequate preparation and development of an application for423
	445	+	a certificate of need;424
	446	+	(8) The commitment of funds conditioned upon the obtaining of a certificate of need;425
	447	+	(9) Expenditures for the restructuring or acquisition of existing health care facilities by426
	448	+	stock or asset purchase, merger, consolidation, or other lawful means;427
	449	+	(9.1) The purchase of a closing hospital or of a hospital that has been closed for no more428
	450	+	than 12 24 months by a hospital in a contiguous county to repurpose the facility as a429
	451	+	micro-hospital;430
	452	+	- 17 - 24 LC 33 9707S
	453	+	(10) Expenditures of less than $870,000.00 for any minor or major for the purchase,431
	454	+	repair, or replacement of any diagnostic, therapeutic, or other imaging equipment by a432
	455	+	health care facility that is not owned by a group practice of physicians or a hospital and433
	456	+	that provides diagnostic imaging services if such facility received a letter of434
	457	+	nonreviewability from the department prior to July 1, 2008. This paragraph shall not435
	458	+	apply to such facilities in rural counties;436
	459	+	(10.1) Except as provided in paragraph (10) of this subsection, an expenditure for the437
	460	+	minor or major repair of a health care facility or a facility that is exempt from the438
	461	+	requirements of this chapter, parts thereof, or services provided or equipment used439
	462	+	therein; or the replacement of equipment, including, but not limited to, CT scanners,440
	463	+	magnetic resonance imaging, positron emission tomography (PET), and positron441
	464	+	emission tomography/computed tomography previously approved for a certificate of442
	465	+	need;443
	466	+	(11) Capital expenditures otherwise covered by this chapter required solely to eliminate444
	467	+	or prevent safety hazards as defined by federal, state, or local fire, building,445
	468	+	environmental, occupational health, or life safety codes or regulations, to comply with446
	469	+	licensing requirements of the department, or to comply with accreditation standards of447
	470	+	a nationally recognized health care accreditation body;448
	471	+	(12) Cost overruns whose percentage of the cost of a project is equal to or less than the449
	472	+	cumulative annual rate of increase in the composite construction index, published by the450
	473	+	United States Bureau of the Census of the Department of Commerce, calculated from the451
	474	+	date of approval of the project;452
	475	+	(13) Transfers from one health care facility to another such facility of major medical453
	476	+	equipment previously approved under or exempted from certificate of need review,454
	477	+	except where such transfer results in the institution of a new clinical health service for455
	478	+	which a certificate of need is required in the facility acquiring such equipment, provided456
	479	+	- 18 - 24 LC 33 9707S
	480	+	that such transfers are recorded at net book value of the medical equipment as recorded457
	481	+	on the books of the transferring facility;458
	482	+	(14) New institutional health services provided by or on behalf of health maintenance459
	483	+	organizations or related health care facilities in circumstances defined by the department460
	484	+	pursuant to federal law;461
	485	+	(15) Increases in the bed capacity of a hospital up to ten beds or 10 20 percent of462
	486	+	capacity, whichever is greater, in any consecutive two-year three-year period, in a463
	487	+	hospital that has maintained an overall occupancy rate greater than 75 60 percent for the464
	488	+	previous 12 month period;465
	489	+	(16) Expenditures for nonclinical projects, including parking lots, parking decks, and466
	490	+	other parking facilities; computer systems, software, and other information technology;467
	491	+	medical office buildings; administrative office space; conference rooms; education468
	492	+	facilities; lobbies; common spaces; clinical staff lounges and sleep areas; waiting rooms;469
	493	+	bathrooms; cafeterias; hallways; engineering facilities; mechanical systems; roofs;470
	494	+	grounds; signage; family meeting or lounge areas; other nonclinical physical plant471
	495	+	renovations or upgrades that do not result in new or expanded clinical health services, and472
	496	+	state mental health facilities;473
	497	+	(17) Life plan communities, provided that the skilled nursing component of the facility474
	498	+	is for the exclusive use of residents of the life plan community and that a written475
	499	+	exemption is obtained from the department; provided, however, that new sheltered476
	500	+	nursing home beds may be used on a limited basis by persons who are not residents of477
	501	+	the life plan community for a period up to five years after the date of issuance of the478
	502	+	initial nursing home license, but such beds shall not be eligible for Medicaid479
	503	+	reimbursement. For the first year, the life plan community sheltered nursing facility may480
	504	+	utilize not more than 50 percent of its licensed beds for patients who are not residents of481
	505	+	the life plan community. In the second year of operation, the life plan community shall482
	506	+	allow not more than 40 percent of its licensed beds for new patients who are not residents483
	507	+	- 19 - 24 LC 33 9707S
	508	+	of the life plan community. In the third year of operation, the life plan community shall484
	509	+	allow not more than 30 percent of its licensed beds for new patients who are not residents485
	510	+	of the life plan community. In the fourth year of operation, the life plan community shall486
	511	+	allow not more than 20 percent of its licensed beds for new patients who are not residents487
	512	+	of the life plan community. In the fifth year of operation, the life plan community shall488
	513	+	allow not more than 10 percent of its licensed beds for new patients who are not residents489
	514	+	of the life plan community. At no time during the first five years shall the life plan490
	515	+	community sheltered nursing facility occupy more than 50 percent of its licensed beds491
	516	+	with patients who are not residents under contract with the life plan community. At the492
	517	+	end of the five-year period, the life plan community sheltered nursing facility shall be493
	518	+	utilized exclusively by residents of the life plan community, and at no time shall a494
	519	+	resident of a life plan community be denied access to the sheltered nursing facility. At495
	520	+	no time shall any existing patient be forced to leave the life plan community to comply496
	521	+	with this paragraph. The department is authorized to promulgate rules and regulations497
	522	+	regarding the use and definition of the term 'sheltered nursing facility' in a manner498
	523	+	consistent with this Code section. Agreements to provide continuing care include499
	524	+	agreements to provide care for any duration, including agreements that are terminable by500
	525	+	either party;501
	526	+	(18)(A) Any single specialty ambulatory surgical center that:502
	527	+	(A)(i) Has capital expenditures associated with the construction, development, or503
	528	+	other establishment of the clinical health service which do not exceed $2.5 million;504
	529	+	or505
	530	+	(ii) Is the only single specialty ambulatory surgical center in the county owned by the506
	531	+	group practice and has two or fewer operating rooms; provided, however, that a center507
	532	+	exempt pursuant to this division shall be required to obtain a certificate of need in508
	533	+	order to add any additional operating rooms;509
	534	+	- 20 - 24 LC 33 9707S
	535	+	(B)(i) Has a hospital affiliation agreement with a hospital within a reasonable510
	536	+	distance from the facility or the medical staff at the center has admitting privileges or511
	537	+	other acceptable documented arrangements with such hospital to ensure the necessary512
	538	+	backup for the center for medical complications. The center shall have the capability513
	539	+	to transfer a patient immediately to a hospital within a reasonable distance from the514
	540	+	facility with adequate emergency room services. Hospitals shall not unreasonably515
	541	+	deny a transfer agreement or affiliation agreement to the center;516
	542	+	(C)(i)(ii)(I) Provides care to Medicaid beneficiaries and, if the facility provides517
	543	+	medical care and treatment to children, to PeachCare for Kids beneficiaries and518
	544	+	provides uncompensated indigent and charity care in an amount equal to or greater519
	545	+	than 2 percent of its adjusted gross revenue the minimum amount established by the520
	546	+	department; or521
	547	+	(ii)(II) If the center is not a participant in Medicaid or the PeachCare for Kids522
	548	+	Program, provides uncompensated care to Medicaid beneficiaries and, if the facility523
	549	+	provides medical care and treatment to children, to PeachCare for Kids524
	550	+	beneficiaries, uncompensated indigent and charity care, or both in an amount equal525
	551	+	to or greater than 4 percent of its adjusted gross revenue the minimum amount526
	552	+	established by the department;527
	553	+	provided, however, that single specialty ambulatory surgical centers owned by528
	554	+	physicians in the practice of ophthalmology shall not be required to comply with this529
	555	+	subparagraph division; and530
	556	+	(D)(iii) Provides annual reports in the same manner and in accordance with Code531
	557	+	Section 31-6-70.;532
	558	+	(B) Noncompliance with any condition of subparagraph (A) of this paragraph shall533
	559	+	result in a monetary penalty in the amount of the difference between the services which534
	560	+	the center is required to provide and the amount actually provided and may be subject535
	561	+	to revocation of its exemption status by the department for repeated failure to pay any536
	562	+	- 21 - 24 LC 33 9707S
	563	+	fines or moneys due to the department or for repeated failure to produce data as537
	564	+	required by Code Section 31-6-70 after notice to the exemption holder and a fair538
	565	+	hearing pursuant to Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.' 539
	566	+	The dollar amount specified in this paragraph shall be adjusted annually by an amount540
	567	+	calculated by multiplying such dollar amount (as adjusted for the preceding year) by541
	568	+	the annual percentage of change in the composite index of construction material prices,542
	569	+	or its successor or appropriate replacement index, if any, published by the United States543
	570	+	Department of Commerce for the preceding calendar year, commencing on July 1,544
	571	+	2009, and on each anniversary thereafter of publication of the index. The department545
	572	+	shall immediately institute rule-making procedures to adopt such adjusted dollar546
	573	+	amounts. In calculating the dollar amounts of a proposed project for purposes of this547
	574	+	paragraph, the costs of all items subject to review by this chapter and items not subject548
	575	+	to review by this chapter associated with and simultaneously developed or proposed549
	576	+	with the project shall be counted, except for the expenditure or commitment of or550
	577	+	incurring an obligation for the expenditure of funds to develop certificate of need551
	578	+	applications, studies, reports, schematics, preliminary plans and specifications or552
	579	+	working drawings, or to acquire sites;553
	580	+	(C) Nothing in this paragraph shall be construed to preclude the sharing of operating554
	581	+	rooms between more than one group practice of physicians of the same or a different555
	582	+	specialty or between more than one sole physician of the same or a different specialty556
	583	+	to qualify for the exemption provided for in this paragraph;557
	584	+	(D) Nothing in this paragraph shall be construed to preclude a single specialty558
	585	+	ambulatory surgical center from employing or utilizing physicians in other specialties559
	586	+	within the center so long as such physicians do not perform any surgical procedures in560
	587	+	the single specialty ambulatory surgical center to qualify for the exemption provided561
	588	+	for in this paragraph;562
	589	+	- 22 - 24 LC 33 9707S
	590	+	(E) Nothing in this paragraph shall be construed to preclude a single specialty563
	591	+	ambulatory surgical center from partnering with physicians in other specialties so long564
	592	+	as the single specialty ambulatory surgical center is owned only by physicians in the565
	593	+	same single specialty to qualify for the exemption provided for in this paragraph;566
	594	+	(19)(A) Any joint venture ambulatory surgical center that:567
	595	+	(A) Has capital expenditures associated with the construction, development, or other568
	596	+	establishment of the clinical health service which do not exceed $5 million;569
	597	+	(B)(i)(I) Provides care to Medicaid beneficiaries and, if the facility provides570
	598	+	medical care and treatment to children, to PeachCare for Kids beneficiaries and571
	599	+	provides uncompensated indigent and charity care in an amount equal to or greater572
	600	+	than 2 percent of its adjusted gross revenue the minimum amount established by the573
	601	+	department; or574
	602	+	(ii)(II) If the center is not a participant in Medicaid or the PeachCare for Kids575
	603	+	Program, provides uncompensated care to Medicaid beneficiaries and, if the facility576
	604	+	provides medical care and treatment to children, to PeachCare for Kids577
	605	+	beneficiaries, uncompensated indigent and charity care, or both in an amount equal578
	606	+	to or greater than 4 percent of its adjusted gross revenue the minimum amount579
	607	+	established by the department; and580
	608	+	(C)(ii) Provides annual reports in the same manner and in accordance with Code581
	609	+	Section 31-6-70.;582
	610	+	(B) Noncompliance with any condition of this paragraph shall result in a monetary583
	611	+	penalty in the amount of the difference between the services which the center is584
	612	+	required to provide and the amount actually provided and may be subject to revocation585
	613	+	of its exemption status by the department for repeated failure to pay any fines or586
	614	+	moneys due to the department or for repeated failure to produce data as required by587
	615	+	Code Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant588
	616	+	to Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.' The dollar589
	617	+	- 23 - 24 LC 33 9707S
	618	+	amount specified in this paragraph shall be adjusted annually by an amount calculated590
	619	+	by multiplying such dollar amount (as adjusted for the preceding year) by the annual591
	620	+	percentage of change in the composite index of construction material prices, or its592
	621	+	successor or appropriate replacement index, if any, published by the United States593
	622	+	Department of Commerce for the preceding calendar year, commencing on July 1,594
	623	+	2009, and on each anniversary thereafter of publication of the index. The department595
	624	+	shall immediately institute rule-making procedures to adopt such adjusted dollar596
	625	+	amounts. In calculating the dollar amounts of a proposed project for purposes of this597
	626	+	paragraph, the costs of all items subject to review by this chapter and items not subject598
	627	+	to review by this chapter associated with and simultaneously developed or proposed599
	628	+	with the project shall be counted, except for the expenditure or commitment of or600
	629	+	incurring an obligation for the expenditure of funds to develop certificate of need601
	630	+	applications, studies, reports, schematics, preliminary plans and specifications or602
	631	+	working drawings, or to acquire sites;603
	632	+	(C) Nothing in this paragraph shall be construed to preclude the sharing of operating604
	633	+	rooms between more than one group practice of physicians of the same or a different605
	634	+	specialty or between more than one sole physician of the same or a different specialty606
	635	+	to qualify for the exemption provided for in this paragraph;607
	636	+	(D) Nothing in this paragraph shall be construed to preclude a joint venture ambulatory608
	637	+	surgical center from employing or utilizing physicians in other specialties within the609
	638	+	center so long as such physicians do not perform any surgical procedures in the joint610
	639	+	venture ambulatory surgical center to qualify for the exemption provided for in this611
	640	+	paragraph;612
	641	+	(E) Nothing in this paragraph shall be construed to preclude a joint venture ambulatory613
	642	+	surgical center from partnering with physicians in other specialties so long as the joint614
	643	+	venture ambulatory surgical center is owned only by physicians in the same single615
	644	+	specialty to qualify for the exemption provided for in this paragraph;616
	645	+	- 24 - 24 LC 33 9707S
	646	+	(20) Expansion of services by an imaging center based on a population needs617
	647	+	methodology taking into consideration whether the population residing in the area served618
	648	+	by the imaging center has a need for expanded services, as determined by the department619
	649	+	in accordance with its rules and regulations, if such imaging center:620
	650	+	(A) Was in existence and operational in this state on January 1, 2008;621
	651	+	(B) Is owned by a hospital or by a physician or a group practice of physicians622
	652	+	comprising at least 80 percent ownership who are currently board certified in radiology;623
	653	+	(C) Provides three or more diagnostic and other imaging services;624
	654	+	(D) Accepts all patients regardless of ability to pay; and625
	655	+	(E) Provides uncompensated indigent and charity care in an amount equal to or greater626
	656	+	than the amount of such care provided by the geographically closest general acute care627
	657	+	hospital; provided, however, that this paragraph shall not apply to an imaging center in628
	658	+	a rural county;629
	659	+	(21) Diagnostic cardiac catheterization in a hospital setting on patients 15 years of age630
	660	+	and older;631
	661	+	(22) Therapeutic cardiac catheterization in hospitals selected by the department prior to632
	662	+	July 1, 2008, to participate in the Atlantic Cardiovascular Patient Outcomes Research633
	663	+	Team (C-PORT) Study and therapeutic cardiac catheterization in hospitals that, as634
	664	+	determined by the department on an annual basis, meet the criteria to participate in the635
	665	+	C-PORT Study but have not been selected for participation; provided, however, that if636
	666	+	the criteria requires a transfer agreement to another hospital, no hospital shall637
	667	+	unreasonably deny a transfer agreement to another hospital;638
	668	+	(23) Infirmaries or facilities operated by, on behalf of, or under contract with the639
	669	+	Department of Corrections or the Department of Juvenile Justice for the sole and640
	670	+	exclusive purpose of providing health care services in a secure environment to prisoners641
	671	+	within a penal institution, penitentiary, prison, detention center, or other secure642
	672	+	correctional institution, including correctional institutions operated by private entities in643
	673	+	- 25 - 24 LC 33 9707S
	674	+	this state which house inmates under the Department of Corrections or the Department644
	675	+	of Juvenile Justice;645
	676	+	(24) The relocation of any skilled nursing facility, intermediate care facility, or646
	677	+	micro-hospital within the same county, any other health care facility in a rural county647
	678	+	within the same county, and any other health care facility in an urban county within a648
	679	+	three-mile five-mile radius of the existing facility so long as the facility does not propose649
	680	+	to offer any new or expanded clinical health services at the new location;650
	681	+	(25) Facilities which are devoted to the provision of treatment and rehabilitative care for651
	682	+	periods continuing for 24 hours or longer for persons who have traumatic brain injury,652
	683	+	as defined in Code Section 37-3-1;653
	684	+	(26) Capital expenditures for a project otherwise requiring a certificate of need if those654
	685	+	expenditures are for a project to remodel, renovate, replace, or any combination thereof,655
	686	+	a medical-surgical hospital and:656
	687	+	(A) That hospital:657
	688	+	(i) Has a bed capacity of not more than 50 beds;658
	689	+	(ii) Is located in a county in which no other medical-surgical hospital is located;659
	690	+	(iii) Has at any time been designated as a disproportionate share hospital by the660
	691	+	department; and661
	692	+	(iv) Has at least 45 percent of its patient revenues derived from medicare, Medicaid,662
	693	+	or any combination thereof, for the immediately preceding three years; and663
	694	+	(B) That project:664
	695	+	(i) Does not result in any of the following:665
	696	+	(I) The offering of any new clinical health services;666
	697	+	(II) Any increase in bed capacity;667
	698	+	(III) Any redistribution of existing beds among existing clinical health services; or668
	699	+	(IV) Any increase in capacity of existing clinical health services;669
	700	+	- 26 - 24 LC 33 9707S
	701	+	(ii) Has at least 80 percent of its capital expenditures financed by the proceeds of a670
	702	+	special purpose county sales and use tax imposed pursuant to Article 3 of Chapter 8671
	703	+	of Title 48; and672
	704	+	(iii) Is located within a three-mile five-mile radius of and within the same county as673
	705	+	the hospital's existing facility;674
	706	+	(27) The renovation, remodeling, refurbishment, or upgrading of a health care facility,675
	707	+	so long as the project does not result in any of the following:676
	708	+	(A) The offering of any new or expanded clinical health services;677
	709	+	(B) Any increase in inpatient bed capacity; or678
	710	+	(C) Any redistribution of existing beds among existing clinical health services; or679
	711	+	(D) A capital expenditure exceeding the threshold contained in paragraph (2) of680
	712	+	subsection (a) of Code Section 31-6-40;681
	713	+	(28) Other than for equipment used to provide positron emission tomography (PET)682
	714	+	services, the The acquisition of diagnostic, therapeutic, or other imaging equipment with683
	715	+	a value of $3 million or less, by or on behalf of:684
	716	+	(A) A hospital; or685
	717	+	(B) An individual private physician or single group practice of physicians exclusively686
	718	+	for use on patients of such private physician or single group practice of physicians and687
	719	+	such private physician or member of such single group practice of physicians is688
	720	+	physically present at the practice location where the diagnostic or other imaging689
	721	+	equipment is located at least 75 percent of the time that the equipment is in use.;690
	722	+	The amount specified in this paragraph shall not include build-out costs, as defined by691
	723	+	the department, but shall include all functionally related equipment, software, and any692
	724	+	warranty and services contract costs for the first five years. The acquisition of one or693
	725	+	more items of functionally related diagnostic or therapeutic equipment shall be694
	726	+	considered as one project. The dollar amount specified in this paragraph and in695
	727	+	paragraph (10) of this subsection shall be adjusted annually by an amount calculated by696
	728	+	- 27 - 24 LC 33 9707S
	729	+	multiplying such dollar amounts (as adjusted for the preceding year) by the annual697
	730	+	percentage of change in the consumer price index, or its successor or appropriate698
	731	+	replacement index, if any, published by the United States Department of Labor for the699
	732	+	preceding calendar year, commencing on July 1, 2010; and700
	733	+	(29) Any capital expenditures A capital expenditure of $10 million or less by a hospital701
	734	+	at such hospital's primary campus for:702
	735	+	(A) The expansion or addition of the following clinical health services: operating703
	736	+	rooms, other than dedicated outpatient operating rooms; medical-surgical services;704
	737	+	gynecology; procedure rooms; intensive care; pharmaceutical services; pediatrics;705
	738	+	cardiac care or other general hospital services; provided, however, that such706
	739	+	expenditure does not include the expansion or addition of inpatient beds or the707
	740	+	conversion of one type of inpatient bed to another type of inpatient bed; or708
	741	+	(B) The movement of clinical health services from one location on the hospital's709
	742	+	primary campus to another location on such hospital's primary campus;710
	743	+	(30) New or expanded psychiatric or substance abuse inpatient programs or contracted711
	744	+	beds that serve Medicaid and uninsured patients that:712
	745	+	(A) Are open 365 days per year, seven days per week, and 24 hours per day;713
	746	+	(B) Provide uncompensated indigent and charity care in an amount equal to or greater714
	747	+	than the minimum amount established by the department;715
	748	+	(C) Participate as providers of medical assistance for Medicaid purposes;716
	749	+	(D) Have hospital affiliation agreements with acute care hospitals within a reasonable717
	750	+	distance from the programs or contracted beds or the medical staffs at the programs or718
	751	+	contracted beds have admitting privileges or other acceptable documented arrangements719
	752	+	with such hospitals to ensure the necessary backup for the programs or contracted beds720
	753	+	for medical complications. The programs or contracted beds shall have the capability721
	754	+	to transfer a patient immediately to a hospital within a reasonable distance from the722
	755	+	programs or contracted beds with adequate emergency room services. Hospitals shall723
	756	+	- 28 - 24 LC 33 9707S
	757	+	not unreasonably deny a transfer agreement or affiliation agreement to the programs or724
	758	+	contracted beds; and725
	759	+	(E) Provide annual reports in the same manner and in accordance with Code Section726
	760	+	31-6-70;727
	761	+	(31) The offering of new or expanded basic perinatal services by a hospital in a rural728
	762	+	county provided that:729
	763	+	(A) Such services are available 365 days per year, seven days per week, and 24 hours730
	764	+	per day;731
	765	+	(B) The hospital participates as a provider of medical assistance for Medicaid732
	766	+	purposes;733
	767	+	(C) The hospital has a hospital affiliation agreement with an acute care hospital with734
	768	+	Level II or III perinatal services within a reasonable distance from the hospital735
	769	+	providing the perinatal services or the medical staff at the hospital providing the736
	770	+	perinatal services has admitting privileges or other acceptable documented737
	771	+	arrangements with such acute care hospital to ensure the necessary backup for the738
	772	+	hospital providing the perinatal services for medical complications. The hospital739
	773	+	providing the perinatal services shall have the capability to transfer a patient740
	774	+	immediately to the acute care hospital within a reasonable distance from the hospital741
	775	+	providing the perinatal services with adequate emergency room services. Acute care742
	776	+	hospitals shall not unreasonably deny a transfer agreement or affiliation agreement to743
	777	+	the hospital providing the perinatal services. This subparagraph shall not apply if the744
	778	+	hospital providing the perinatal services is itself an acute care hospital with Level II or745
	779	+	III perinatal services; and746
	780	+	(D) Provides annual reports in the same manner and in accordance with Code Section747
	781	+	31-6-70;748
	782	+	- 29 - 24 LC 33 9707S
	783	+	(31.1) Any new or expanded building or facility where human births occur on a regular749
	784	+	and ongoing basis and which is classified as a birthing center by the department for750
	785	+	purposes of Chapter 7 of this title, provided that:751
	786	+	(A) Such services are available 365 days per year, seven days per week, and 24 hours752
	787	+	per day;753
	788	+	(B) The birthing center participates as a provider of medical assistance for Medicaid754
	789	+	purposes;755
	790	+	(C) The birthing center has a hospital affiliation agreement with an acute care hospital756
	791	+	with Level II or III perinatal services within a reasonable distance from the birthing757
	792	+	center or the medical staff at the birthing center has admitting privileges or other758
	793	+	acceptable documented arrangements with such acute care hospital to ensure the759
	794	+	necessary backup for the birthing center for medical complications. The birthing center760
	795	+	shall have the capability to transfer a patient immediately to the acute care hospital761
	796	+	within a reasonable distance from the birthing center. Acute care hospitals shall not762
	797	+	unreasonably deny a transfer agreement or affiliation agreement to the birthing center;763
	798	+	and764
	799	+	(D) Provides annual reports in the same manner and in accordance with Code Section765
	800	+	31-6-70;766
	801	+	(32) A new general acute care hospital in a rural county that:767
	802	+	(A) Will seek, and maintain thereafter, clinical training affiliation agreements to serve768
	803	+	as a host hospital facility for medical training programs for physicians, nurses,769
	804	+	pharmacists, and other medical training programs, as appropriate and as practicable;770
	805	+	(B) Obtains verification as a Level I, II, III, or IV trauma center from the American771
	806	+	College of Surgeons and maintains such verification thereafter;772
	807	+	(C) Has an emergency department that provides emergency medical screening,773
	808	+	emergency stabilization, and appropriate treatment within its capability and availability774
	809	+	for medical and psychiatric patients or can transfer the patient to an appropriate facility775
	810	+	- 30 - 24 LC 33 9707S
	811	+	providing more specialized emergency care in accordance with the federal Emergency776
	812	+	Medical Treatment and Active Labor Act;777
	813	+	(D) Provides uncompensated indigent and charity care in an amount equal to or greater778
	814	+	than the minimum amount established by the department;779
	815	+	(E) Participates as a provider of medical assistance for Medicaid purposes; and780
	816	+	(F) Provides annual reports in the same manner and in accordance with Code Section781
	817	+	31-6-70;782
	818	+	(33) A new acute care hospital where a short-stay general hospital in a rural county has783
	819	+	been closed for more than 12 months that:784
	820	+	(A) Is located in the same rural county where the short-stay general hospital was785
	821	+	closed;786
	822	+	(B) Has no more than the number of licensed beds that were previously licensed in the787
	823	+	closed hospital;788
	824	+	(C) Has an emergency department;789
899	825		(D) Provides all required clinical health services as generally offered by a short-stay790
900	826		general hospital to meet licensure requirements; and791
901	827		(E) Provides uncompensated indigent and charity care in an amount equal to or greater792
902		-	than 3 percent of its adjusted gross revenue, and on and after January 1, 2026, in an793
903		-	amount equal to or greater than the minimum amount established by the department by794
904		-	rule which shall be no less than 3 percent and which shall be reviewed by the795
905		-	department every 12 months.796
906		-	Such new acute care hospital may provide basic perinatal services;797
907		-	(34)(A) A new short-stay general hospital to address the underserved population798
908		-	previously served by a short-stay general hospital that was closed within the 48 months799
909		-	preceding the filing of a request for a letter of determination that:800
910		-	(i) Is located within a county with a population of more than 1 million according to801
911		-	the United States decennial census of 2020 or any future such census;802
912		-	(ii) Is located within five miles of and in the same county as the main campus of a803
913		-	medical school that is accredited by the Liaison Committee on Medical Education to804
914		-	confer Doctor of Medicine (M.D.) degrees;805
915		-	(iii) Has in place at the time of filing of a request for a letter of determination a806
916		-	written agreement to serve as a teaching hospital for students of the medical school807
917		-	described in division (ii) of this subparagraph;808
918		-	(iv) Has a maximum number of short-stay general hospital beds not greater than 50809
919		-	percent of the maximum number of short-stay general hospital beds for which the810
920		-	closed short-stay general hospital had previously been licensed at any time during the811
921		-	12 months prior to its closure;812
922		-	H. B. 1339
923		-	- 31 - 24 HB 1339/AP
924		-	(v) Has an emergency department that is open 365 days per year, seven days per813
925		-	week, and 24 hours per day; and814
926		-	(vi) Provides uncompensated indigent and charity care in an amount equal to or815
927		-	greater than 3 percent of its adjusted gross revenue, and on and after January 1, 2026,816
928		-	in an amount equal to or greater than the minimum amount established by the817
929		-	department by rule which shall be no less than 3 percent and which shall be reviewed818
930		-	by the department every 12 months;819
931		-	(B) An exemption for a new short-stay general hospital under this paragraph shall820
932		-	include an exemption for all clinical services and equipment generally utilized at an821
933		-	acute care short-stay general hospital and required for licensure, including, but not822
934		-	limited to, an emergency department; Level II perinatal/neonatal services, including823
935		-	labor, delivery, recovery, and Level II neonatal intermediate care services; diagnostic824
936		-	imaging services; and surgical services; and825
937		-	(C) For a period of ten years following the issuance of its original license, a new826
938		-	short-stay general hospital approved for an exemption pursuant to this paragraph shall827
939		-	be entitled to one or more determinations from the department to add additional828
940		-	short-stay general hospital beds, so long as the total licensed capacity of such hospital829
941		-	does not exceed the maximum number of short-stay general hospital beds for which the830
942		-	closed short-stay general hospital had previously been licensed at any time during the831
943		-	12 months prior to its closure; and832
944		-	(35) Transfer of existing beds from one general acute care hospital's primary campus to833
945		-	another general acute care hospital's primary campus within the same hospital system834
946		-	within a 15 mile radius of the original campus, provided that all of the following are835
947		-	satisfied:836
948		-	(A) Both hospitals involved in the transfer are general acute care hospitals and neither837
949		-	is a specialty hospital;838
950		-	(B) Both hospitals involved in the transfer are under common ownership or control;839
951		-	H. B. 1339
952		-	- 32 - 24 HB 1339/AP
953		-	(C) The transferring hospital may not, for a period of 12 months after the transfer is840
954		-	effective, seek to expand the bed type which was transferred; and841
955		-	(D) The transferring hospital is open and operational at the time of transfer and shall842
956		-	not close within 12 months after the transfer is effective.843
957		-	(b) By rule, the department shall establish a procedure for expediting or waiving reviews844
958		-	of certain projects, the nonreview of which it deems compatible with the purposes of this845
959		-	chapter, in addition to expenditures exempted from review by this Code section."846
960		-	SECTION 8.847
961		-	Said title is further amended by revising Code Section 31-6-47.1, relating to prior notice and848
962		-	approval of certain activities, as follows:849
963		-	"31-6-47.1.850
964		-	(a) The department shall require prior notice from a new health care facility for approval851
965		-	of any activity which is believed to be exempt pursuant to Code Section 31-6-47 or852
966		-	excluded from the requirements of this chapter under other provisions of this chapter. The853
967		-	department shall require prior notice and approval of any activity which is believed to be854
968		-	exempt pursuant to paragraphs (31.1), (32), (33), and (34) of subsection (a) of Code855
969		-	Section 31-6-47. The department may require prior notice and approval of any activity856
970		-	which is believed to be exempt pursuant to paragraphs (10), (15), (16), (17), (20), (21),857
971		-	(23), (25), (26), (27), (28), and (29), (30), and (31) of subsection (a) of Code Section858
972		-	31-6-47. The department shall establish timeframes, forms, and criteria to request a letter859
973		-	of determination that an activity is properly exempt or excluded under this chapter prior to860
974		-	its implementation. The department shall publish notice of all requests for letters of861
975		-	determination regarding exempt activity and opposition to such request. Persons opposing862
976		-	a request for approval of an exempt activity shall be entitled to file an objection with the863
977		-	department and the department shall consider any filed objection when determining864
978		-	whether an activity is exempt. After the department's decision, an opposing party shall865
979		-	H. B. 1339
980		-	- 33 - 24 HB 1339/AP
981		-	have the right to a fair hearing pursuant to Chapter 13 of Title 50, the 'Georgia
982		-	866
983		-	Administrative Procedure Act,' on an adverse decision of the department and judicial867
984		-	review of a final decision in the same manner and under the same provisions as in Code868
985		-	Section 31-6-44.1. If no objection to a request for determination is filed within 30 days of869
986		-	the department's receipt of such request for determination, the department shall have 60870
987		-	days from the date of the department's receipt of such request to review the request and871
988		-	issue a letter of determination. The department may adopt rules for deciding when it is not872
989		-	practicable to provide a determination in 60 days and may extend the review period upon873
990		-	written notice to the requestor but only for an extended period of no longer than an874
991		-	additional 30 days.875
992		-	(b) Noncompliance with any condition of paragraph (30), (31), (31.1), or (32) of
993		-	876
994		-	subsection (a) of Code Section 31-6-47 shall result in a monetary penalty in the amount of877
995		-	the difference between the services which the exemption holder is required to provide and878
996		-	the amount actually provided and shall be subject to revocation of its exemption status by879
997		-	the department for repeated failure to meet any one or more requirements for the880
998		-	exemption, for repeated failure to pay any fines or moneys due to the department, or for881
999		-	repeated failure to produce data as required by Code Section 31-6-70 after notice to the882
1000		-	exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the 'Georgia883
1001		-	Administrative Procedure Act.'"884
1002		-	SECTION 9.885
1003		-	Said title is further amended in Article 3 of Chapter 6, relating to the Certificate of Need886
1004		-	Program, by adding a new Code section to read as follows:887
1005		-	"31-6-51.888
1006		-	(a) The department, in conjunction with the Office of Legislative Counsel, shall review the889
1007		-	statutory framework and provisions of this chapter and the certificate of need program890
1008		-	generally and shall make recommendations relating to rewriting, reorganizing, and891
1009		-	H. B. 1339
1010		-	- 34 - 24 HB 1339/AP
1011		-	clarifying the provisions of this chapter. Such review shall also include recommendations892
1012		-	to streamline the statutory procedures required to obtain a certificate of need or a letter of893
1013		-	determination.894
1014		-	(b) The department may consult with and obtain input from certificate of need applicants,895
1015		-	certificate of need holders, local government representatives, citizens, or other interested896
1016		-	parties in conducting such review.897
1017		-	(c) The department shall submit its recommendations to the General Assembly, which may898
1018		-	include proposed legislation, no later than December 1, 2024.899
1019		-	(d) This Code section shall stand repealed on December 31, 2024."900
1020		-	SECTION 10.901
1021		-	Said title is further amended in Code Section 31-6-70, relating to reports to the department902
1022		-	by certain health care facilities an all ambulatory surgical centers and imaging centers and903
1023		-	public availability, by revising subsection (e) as follows:904
1024		-	"(e)(1) In the event the department does not receive an annual report from a health care905
1025		-	facility requiring a certificate of need or an ambulatory surgical center or imaging center,906
1026		-	whether or not exempt from obtaining a certificate of need under this chapter, on or907
1027		-	before the date such report was due or receives a timely but incomplete report, the908
1028		-	department shall notify the health care facility or center regarding the deficiencies and909
1029		-	shall be authorized to fine such health care facility or center an amount not to exceed910
1030		-	$500.00 $2,000.00 per day for every day up to 30 days and $1,000.00 $5,000.00 per day911
1031		-	for every day over 30 days for every day of such untimely or deficient report.912
1032		-	(2) In the event the department does not receive an annual report from a health care913
1033		-	facility within 180 days following the date such report was due or receives a timely but914
1034		-	incomplete report which is not completed within such 180 days, the department shall be915
1035		-	authorized to revoke such health care facility's certificate of need in accordance with916
1036		-	Code Section 31-6-45."917
1037		-	H. B. 1339
1038		-	- 35 - 24 HB 1339/AP
1039		-	SECTION 11.
1040		-	918
1041		-	Code Section 48-7-29.20 of the Official Code of Georgia Annotated, relating to tax credits919
1042		-	for contributions to rural hospital organizations, is amended by revising subsections (b.1),920
1043		-	(e), and (k) as follows:921
1044		-	"(b.1) From January 1 to June 30 each taxable year, an individual taxpayer shall be limited922
1045		-	in its qualified rural hospital organization expenses allowable for credit under this Code923
1046		-	section, and the commissioner shall not approve qualified rural hospital organization924
1047		-	expenses incurred from January 1 to June 30 each taxable year, which exceed the following925
1048		-	limits:926
1049		-	(1) In the case of a single individual or a head of household, $5,000.00;927
1050		-	(2) In the case of a married couple filing a joint return, $10,000.00; or928
1051		-	(3) In the case of an individual who is a member of a limited liability company duly929
1052		-	formed under state law, a shareholder of a Subchapter 'S' corporation, or a partner in a930
1053		-	partnership, $10,000.00
1054		-	$25,000.00."931
1055		-	"(e)(1) In no event shall the aggregate amount of tax credits allowed under this Code932
1056		-	section exceed $75 $100 million per taxable year.933
1057		-	(2)(A) No more than $4 million of the aggregate limit established by paragraph (1) of934
1058		-	this subsection shall be contributed to any individual rural hospital organization in any935
1059		-	taxable year. From January 1 to June 30 each taxable year, the commissioner shall only936
1060		-	preapprove contributions submitted by individual taxpayers in an amount not to exceed937
1061		-	$2 million, and from corporate donors in an amount not to exceed $2 million. From938
1062		-	July 1 to December 31 each taxable year, subject to the aggregate limit in paragraph (1)939
1063		-	of this subsection and the individual rural hospital organization limit in this paragraph,940
1064		-	the commissioner shall approve contributions submitted by individual taxpayers and941
1065		-	corporations or other entities.942
1066		-	(B) In the event an individual or corporate donor desires to make a contribution to an943
1067		-	individual rural hospital organization that has received the maximum amount of944
1068		-	H. B. 1339
1069		-	- 36 - 24 HB 1339/AP
1070		-	contributions for that taxable year, the Department of Community Health shall provide945
1071		-	the individual or corporate donor with a list, ranked in order of financial need, as946
1072		-	determined by the Department of Community Health, of rural hospital organizations947
1073		-	still eligible to receive contributions for the taxable year.948
1074		-	(C) In the event an individual or corporate donor desires to make a contribution to an949
1075		-	individual rural hospital organization that would cause such rural hospital organization950
1076		-	to exceed its maximum amount of contributions for that year, the commissioner shall951
1077		-	not deny such desired contribution, but shall approve the proportional amount of the952
1078		-	desired contribution up to the rural hospital organization's maximum allowed amount953
1079		-	and any remainder shall be attributed as provided for in subparagraph (D) of this954
1080		-	paragraph.955
1081		-	(C)(D) In the event that an individual or corporate donor desires to make a contribution956
1082		-	to an unspecified or undesignated rural hospital organization, either directly to the957
1083		-	department or through a third party that participates in soliciting, administering, or958
1084		-	managing donations, such donation shall be attributed to the rural hospital organization959
1085		-	ranked with the highest financial need that has not yet received the maximum amount960
1086		-	of contributions for that taxable year, regardless of whether a third party has a961
1087		-	contractual relationship or agreement with such rural hospital organization.962
1088		-	(D)(E) Any third party that participates in soliciting, advertising, or managing963
1089		-	donations shall provide the complete list of rural hospital organizations eligible to964
1090		-	receive the tax credit provided pursuant to this Code section including their ranking in965
1091		-	order of financial need as determined by the Department of Community Health966
1092		-	pursuant to Code Section 31-8-9.1, to any potential donor regardless of whether a third967
1093		-	party has a contractual relationship or agreement with such rural hospital organization.968
1094		-	(3) For purposes of paragraphs (1) and (2) of this subsection, a rural hospital969
1095		-	organization shall notify a potential donor of the requirements of this Code section. 970
1096		-	Before making a contribution to a rural hospital organization, the taxpayer shall971
1097		-	H. B. 1339
1098		-	- 37 - 24 HB 1339/AP
1099		-	electronically notify the department, in a manner specified by the department, of the total
1100		-	972
1101		-	amount of contribution that the taxpayer intends to make to the rural hospital973
1102		-	organization. The commissioner shall preapprove or deny the requested amount or a
1103		-	974
1104		-	portion of such amount, if applicable pursuant to subparagraph (C) of paragraph (2) of975
1105		-	this subsection, within 30 days after receiving the request from the taxpayer and shall976
1106		-	provide written notice to the taxpayer and rural hospital organization of such preapproval977
1107		-	or denial which shall not require any signed release or notarized approval by the taxpayer. 978
1108		-	In order to receive a tax credit under this Code section, the taxpayer shall make the979
1109		-	contribution to the rural hospital organization within 180 days after receiving notice from980
1110		-	the department that the requested amount was preapproved. In order to receive a tax981
1111		-	credit under this Code section, a taxpayer preapproved by the commissioner on or before982
1112		-	September 30 shall make the contribution to the rural hospital organization within 180983
1113		-	days after receiving notice of preapproval from the commissioner, but not later than984
1114		-	October 31. A taxpayer preapproved by the commissioner after September 30 shall make985
1115		-	the contribution to the rural hospital organization on or before December 31. If the986
1116		-	taxpayer does not comply with this paragraph, the commissioner shall not include this987
1117		-	preapproved contribution amount when calculating the limits prescribed in paragraphs988
1118		-	(1) and (2) of this subsection.989
1119		-	(4)(A) Preapproval of contributions by the commissioner shall be based solely on the990
1120		-	availability of tax credits subject to the aggregate total limit established under991
1121		-	paragraph (1) of this subsection and the individual rural hospital organization limit992
1122		-	established under paragraph (2) of this subsection.993
1123		-	(B) Any taxpayer preapproved by the department commissioner pursuant to this994
1124		-	subsection shall retain their approval in the event the credit percentage in this Code995
1125		-	section is modified for the year in which the taxpayer was preapproved.996
1126		-	(C) Upon the rural hospital organization's confirmation of receipt of donations that997
1127		-	have been preapproved by the department commissioner, any taxpayer preapproved by998
1128		-	H. B. 1339
1129		-	- 38 - 24 HB 1339/AP
1130		-	the department commissioner pursuant to subsection (c) of this Code section shall999
1131		-	receive the full benefit of the income tax credit established by this Code section even1000
1132		-	though the rural hospital organization to which the taxpayer made a donation does not1001
1133		-	properly comply with the reports or filings required by this Code section.1002
1134		-	(5) Notwithstanding any laws to the contrary, the department shall not take any adverse1003
1135		-	action against donors to rural hospital organizations if the commissioner preapproved a1004
1136		-	donation for a tax credit prior to the date the rural hospital organization is removed from1005
1137		-	the Department of Community Health list pursuant to Code Section 31-8-9.1, and all such1006
1138		-	donations shall remain as preapproved tax credits subject only to the donor's compliance1007
1139		-	with paragraph (3) of this subsection."1008
1140		-	"(k) This Code section shall stand automatically repealed and reserved on December 31,1009
1141		-	2024 2029."1010
1142		-	SECTION 12.1011
1143		-	Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to1012
1144		-	medical assistance generally, is amended by adding a new Code section to read as follows:1013
1145		-	"49-4-156.1014
1146		-	(a) There is created the Comprehensive Health Coverage Commission. The commission1015
1147		-	shall be attached to the Department of Community Health for administrative purposes only1016
1148		-	as provided by Code Section 50-4-3.1017
1149		-	(b) The commission shall consist of nine members, who shall be appointed no later than1018
1150		-	July 1, 2024, as follows:1019
1151		-	(1) The chairperson, who shall be a subject matter expert on health policy, and shall not1020
1152		-	be an employee of the State of Georgia, to be appointed by the Governor;1021
1153		-	(2) Three nonlegislative members to be appointed by the Speaker of the House of1022
1154		-	Representatives;1023
1155		-	(3) Three nonlegislative members to be appointed by the President of the Senate;1024
1156		-	H. B. 1339
1157		-	- 39 - 24 HB 1339/AP
1158		-	(4) One nonlegislative member to be appointed by the minority leader of the Senate; and1025
1159		-	(5) One nonlegislative member to be appointed by the minority leader of the House of1026
1160		-	Representatives.1027
1161		-	(c) Members of the commission shall not be registered lobbyists in the State of Georgia.1028
1162		-	(d) Members of the commission shall serve without compensation.1029
1163		-	(e) The purpose of the commission shall be to advise the Governor, the General Assembly,1030
1164		-	and the Department of Community Health, as the administrator of the state medical1031
1165		-	assistance program, on issues related to access and quality of healthcare for Georgia's1032
1166		-	low-income and uninsured populations. The commission shall be tasked with reviewing1033
1167		-	the following:1034
1168		-	(1) Opportunities related to reimbursement and funding for Georgia healthcare providers,1035
1169		-	including premium assistance programs;1036
1170		-	(2) Opportunities related to quality improvement of healthcare for Georgia's low-income1037
1171		-	and uninsured populations; and1038
1172		-	(3) Opportunities to enhance service delivery and coordination of healthcare among and1039
1173		-	across state agencies.1040
1174		-	(f) Subject to appropriations, the commission shall contract with experts and consultants1041
1175		-	to produce a semiannual report on its findings for the Governor and the General Assembly. 1042
1176		-	The commission shall provide its initial report to the Governor and the General Assembly1043
1177		-	no later than December 1, 2024.1044
1178		-	(g) The commission shall stand abolished on December 31, 2026, unless extended by the1045
1179		-	General Assembly prior to such date."1046
1180		-	SECTION 13.1047
1181		-	(a) Sections 2, 9, 12, 13, and 14 of this Act shall become effective upon approval of the Act1048
1182		-	by the Governor or upon its becoming law without such approval.1049
1183		-	(b) Sections 1, 3, 4, 5, 6, 7, 8, and 10 of this Act shall become effective on July 1, 2024.1050
1184		-	H. B. 1339
1185		-	- 40 - 24 HB 1339/AP
1186		-	(c) Section 11 of this Act shall become effective on January 1, 2025, and shall be applicable
1187		-	1051
1188		-	to taxable years beginning on or after January 1, 2025.1052
1189		-	SECTION 14.1053
1190		-	All laws and parts of laws in conflict with this Act are repealed.1054
1191		-	H. B. 1339
1192		-	- 41 -
	828	+	than the minimum amount established by the department.793
	829	+	Such new acute care hospital may provide basic perinatal services;794
	830	+	(34)(A) A new short-stay general hospital to address the underserved population795
	831	+	previously served by a short-stay general hospital that was closed within the 24 months796
	832	+	preceding the filing of a request for a letter of determination that:797
	833	+	(i) Is located within a county with a population of more than 1,000,000 according to798
	834	+	the United States decennial census of 2020 or any future such census;799
	835	+	(ii) Is located within five miles of and in the same county as the main campus of a800
	836	+	medical school that is accredited by the Liaison Committee on Medical Education to801
	837	+	confer Doctor of Medicine (M.D.) degrees;802
	838	+	- 31 - 24 LC 33 9707S
	839	+	(iii) Has in place at the time of filing of a request for a letter of determination a803
	840	+	written agreement to serve as a teaching hospital for students of the medical school804
	841	+	described in division (ii) of this subparagraph;805
	842	+	(iv) Has a maximum number of short-stay general hospital beds not greater than 50806
	843	+	percent of the maximum number of short-stay general hospital beds for which the807
	844	+	closed short-stay general hospital had previously been licensed at any time during the808
	845	+	12 months prior to its closure;809
	846	+	(v) Has an emergency department; and810
	847	+	(vi) Provides uncompensated indigent and charity care in an amount equal to or811
	848	+	greater than the minimum amount established by the department;812
	849	+	(B) An exemption for a new short-stay general hospital under this paragraph shall813
	850	+	include an exemption for all clinical services and equipment generally utilized at an814
	851	+	acute care short-stay general hospital and required for licensure, including, but not815
	852	+	limited to, an emergency department; Level II perinatal/neonatal services, including816
	853	+	labor, delivery, recovery, and Level II neonatal intermediate care services; diagnostic817
	854	+	imaging services; surgical services; and any other clinical health service that had been818
	855	+	provided by the closed short-stay hospital within the 24 month period prior to its819
	856	+	closure, except for such services not otherwise identified in this subparagraph for which820
	857	+	the department has previously adopted separate service specific rules;821
	858	+	(C) For a period of ten years following the issuance of its original license, a new822
	859	+	short-stay general hospital approved for an exemption pursuant to this paragraph shall823
	860	+	be entitled to one or more determinations from the department to add additional824
	861	+	short-stay general hospital beds, so long as the total licensed capacity of such hospital825
	862	+	does not exceed the number of beds authorized under division (iv) of subparagraph (A)826
	863	+	of this paragraph; and827
	864	+	(35) Transfer of existing beds or services from one general acute care hospital's primary828
	865	+	campus to another general acute care hospital's primary campus within the same hospital829
	866	+	- 32 - 24 LC 33 9707S
	867	+	system within a fifteen-mile radius of the original campus; provided that all of the830
	868	+	following are satisfied:831
	869	+	(A) Both hospitals involved in the transfer are general acute care hospitals and neither832
	870	+	is a specialty hospital;833
	871	+	(B) Both hospitals involved in the transfer are under common ownership or control;834
	872	+	(C) The transferring hospital may not, for a period of 12 months after the transfer is835
	873	+	effective, seek to expand the service or bed type which was transferred; and836
	874	+	(D) The transferring hospital is open and operational at the time of transfer and shall837
	875	+	not close within 12 months after the transfer is effective.838
	876	+	(b) By rule, the department shall establish a procedure for expediting or waiving reviews839
	877	+	of certain projects, the nonreview of which it deems compatible with the purposes of this840
	878	+	chapter, in addition to expenditures exempted from review by this Code section."841
	879	+	SECTION 7.842
	880	+	Said title is further amended by revising Code Section 31-7-47.1, relating to prior notice and843
	881	+	approval of certain activities, as follows:844
	882	+	"31-6-47.1.845
	883	+	(a) The department shall require prior notice from a new health care facility for approval846
	884	+	of any activity which is believed to be exempt pursuant to Code Section 31-6-47 or847
	885	+	excluded from the requirements of this chapter under other provisions of this chapter. The848
	886	+	department shall require prior notice and approval of any activity which is believed to be849
	887	+	exempt pursuant to paragraphs (32), (33), and (34) of subsection (a) of Code Section850
	888	+	31-6-47. The department may require prior notice and approval of any activity which is851
	889	+	believed to be exempt pursuant to paragraphs (10), (15), (16), (17), (20), (21), (23), (25),852
	890	+	(26), (27), (28), and (29), (30), and (31) of subsection (a) of Code Section 31-6-47. The853
	891	+	department shall establish timeframes, forms, and criteria to request a letter of854
	892	+	determination that an activity is properly exempt or excluded under this chapter prior to its855
	893	+	- 33 - 24 LC 33 9707S
	894	+	implementation. The department shall publish notice of all requests for letters of856
	895	+	determination regarding exempt activity and opposition to such request. Persons opposing857
	896	+	a request for approval of an exempt activity shall be entitled to file an objection with the858
	897	+	department and the department shall consider any filed objection when determining859
	898	+	whether an activity is exempt. After the department's decision, an opposing party shall860
	899	+	have the right to a fair hearing pursuant to Chapter 13 of Title 50, the 'Georgia861
	900	+	Administrative Procedure Act,' on an adverse decision of the department and judicial862
	901	+	review of a final decision in the same manner and under the same provisions as in Code863
	902	+	Section 31-6-44.1. If no objection to a request for determination is filed within 30 days of864
	903	+	the department's receipt of such request for determination, the department shall have 60865
	904	+	days from the date of the department's receipt of such request to review the request and866
	905	+	issue a letter of determination. The department may adopt rules for deciding when it is not867
	906	+	practicable to provide a determination in 60 days and may extend the review period upon868
	907	+	written notice to the requestor but only for an extended period of no longer than an869
	908	+	additional 30 days.870
	909	+	(b) Noncompliance with any condition of paragraph (30), (31), or (32) of subsection (a)871
	910	+	of Code Section 31-7-47 shall result in a monetary penalty in the amount of the difference872
	911	+	between the services which the exemption holder is required to provide and the amount873
	912	+	actually provided and may be subject to revocation of its exemption status by the874
	913	+	department for failure to meet any one or more requirements for the exemption, for875
	914	+	repeated failure to pay any fines or moneys due to the department, or for repeated failure876
	915	+	to produce data as required by Code Section 31-6-70 after notice to the exemption holder877
	916	+	and a fair hearing pursuant to Chapter 13 of Title 50, the 'Georgia Administrative878
	917	+	Procedure Act.'"879
	918	+	- 34 - 24 LC 33 9707S
	919	+	SECTION 8.880
	920	+	Said title is further amended in Article 3 of Chapter 6, relating to the Certificate of Need881
	921	+	Program, by adding a new Code section to read as follows:882
	922	+	"31-6-51.883
	923	+	(a) The department, in conjunction with the Office of Legislative Counsel, shall review the884
	924	+	statutory framework and provisions of this chapter and the certificate of need program885
	925	+	generally and shall make recommendations relating to rewriting, reorganizing, and886
	926	+	clarifying the provisions of this chapter. Such review shall also include recommendations887
	927	+	to streamline the statutory procedures required to obtain a certificate of need or a letter of888
	928	+	determination.889
	929	+	(b) The department may consult with and obtain input from certificate of need applicants,890
	930	+	certificate of need holders, local government representatives, citizens, or other interested891
	931	+	parties in conducting such review.892
	932	+	(c) The department shall submit its recommendations to the General Assembly, which may893
	933	+	include proposed legislation, no later than December 1, 2024.894
	934	+	(d) This Code section shall stand repealed on December 31, 2024."895
	935	+	SECTION 9.896
	936	+	Said title is further amended in Code Section 31-6-70, relating to reports to the department897
	937	+	by certain health care facilities an all ambulatory surgical centers and imaging centers and898
	938	+	public availability, by revising subsection (e) as follows:899
	939	+	"(e)(1) In the event the department does not receive an annual report from a health care900
	940	+	facility requiring a certificate of need or an ambulatory surgical center or imaging center,901
	941	+	whether or not exempt from obtaining a certificate of need under this chapter, on or902
	942	+	before the date such report was due or receives a timely but incomplete report, the903
	943	+	department shall notify the health care facility or center regarding the deficiencies and904
	944	+	shall be authorized to fine such health care facility or center an amount not to exceed905
	945	+	- 35 - 24 LC 33 9707S
	946	+	$500.00 $2,000.00 per day for every day up to 30 days and $1,000.00 $5,000.00 per day906
	947	+	for every day over 30 days for every day of such untimely or deficient report.907
	948	+	(2) In the event the department does not receive an annual report from a health care908
	949	+	facility within 180 days following the date such report was due or receives a timely but909
	950	+	incomplete report which is not completed within such 180 days, the department shall be910
	951	+	authorized to revoke such health care facility's certificate of need in accordance with911
	952	+	Code Section 31-6-45."912
	953	+	SECTION 10.913
	954	+	Said title is further amended in Code Section 31-8-9.1, relating to eligibility to receive tax914
	955	+	credits, by revising paragraph (3) of subsection (a) as follows:915
	956	+	"(3) 'Rural hospital organization' means an acute care hospital or rural freestanding916
	957	+	emergency department licensed by the department pursuant to Article 1 of Chapter 7 of917
	958	+	this title that:918
	959	+	(A) Has its primary campus Provides inpatient hospital services at a facility located in919
	960	+	a rural county or is a critical access hospital;920
	961	+	(B) Participates in both Medicaid and medicare and accepts both Medicaid and921
	962	+	medicare patients;922
	963	+	(C) Provides health care services to indigent patients;923
	964	+	(D) Has at least 10 percent of its annual net revenue categorized as indigent care,924
	965	+	charity care, or bad debt;925
	966	+	(E) Annually files IRS Form 990, Return of Organization Exempt From Income Tax,926
	967	+	with the department, or for any hospital not required to file IRS Form 990, the927
	968	+	department will provide a form that collects the same information to be submitted to the928
	969	+	department on an annual basis;929
	970	+	- 36 - 24 LC 33 9707S
	971	+	(F) Is operated by a county or municipal authority pursuant to Article 4 of Chapter 7930
	972	+	of this title or is designated as a tax-exempt organization under Section 501(c)(3) of the931
	973	+	Internal Revenue Code;932
	974	+	(G) Is current with all audits and reports required by law; and933
	975	+	(H) Has a three-year average patient margin, as a percent of expense, less than one934
	976	+	standard deviation above the state-wide three-year average of organizations defined in935
	977	+	subparagraphs (A) through (G) of this paragraph, as calculated by the department. For936
	978	+	purposes of this subparagraph, the term 'patient margin' means gross patient revenues937
	979	+	less contractual adjustments, bad debt, indigent and charity care, other uncompensated938
	980	+	care, and total expenses."939
	981	+	SECTION 11.940
	982	+	Code Section 48-7-29.20 of the Official Code of Georgia Annotated, relating to tax credits941
	983	+	for contributions to rural hospital organizations, is amended by revising subsections (b.1),942
	984	+	(e), and (k) as follows:943
	985	+	"(b.1) From January 1 to June 30 each taxable year, an individual taxpayer shall be limited944
	986	+	in its qualified rural hospital organization expenses allowable for credit under this Code945
	987	+	section, and the commissioner shall not approve qualified rural hospital organization946
	988	+	expenses incurred from January 1 to June 30 each taxable year, which exceed the following947
	989	+	limits:948
	990	+	(1) In the case of a single individual or a head of household, $5,000.00;949
	991	+	(2) In the case of a married couple filing a joint return, $10,000.00; or950
	992	+	(3) In the case of an individual who is a member of a limited liability company duly951
	993	+	formed under state law, a shareholder of a Subchapter 'S' corporation, or a partner in a952
	994	+	partnership, $10,000.00 $25,000.00."953
	995	+	"(e)(1) In no event shall the aggregate amount of tax credits allowed under this Code954
	996	+	section exceed $75 $100 million per taxable year.955
	997	+	- 37 - 24 LC 33 9707S
	998	+	(2)(A) No more than $4 million of the aggregate limit established by paragraph (1) of956
	999	+	this subsection shall be contributed to any individual rural hospital organization in any957
	1000	+	taxable year. From January 1 to June 30 each taxable year, the commissioner shall only958
	1001	+	preapprove contributions submitted by individual taxpayers in an amount not to exceed959
	1002	+	$2 million, and from corporate donors in an amount not to exceed $2 million. From960
	1003	+	July 1 to December 31 each taxable year, subject to the aggregate limit in paragraph (1)961
	1004	+	of this subsection and the individual rural hospital organization limit in this paragraph,962
	1005	+	the commissioner shall approve contributions submitted by individual taxpayers and963
	1006	+	corporations or other entities.964
	1007	+	(B) In the event an individual or corporate donor desires to make a contribution to an965
	1008	+	individual rural hospital organization that has received the maximum amount of966
	1009	+	contributions for that taxable year, the Department of Community Health shall provide967
	1010	+	the individual or corporate donor with a list, ranked in order of financial need, as968
	1011	+	determined by the Department of Community Health, of rural hospital organizations969
	1012	+	still eligible to receive contributions for the taxable year.970
	1013	+	(C) In the event an individual or corporate donor desires to make a contribution to an971
	1014	+	individual rural hospital organization that would cause such rural hospital organization972
	1015	+	to exceed its maximum amount of contributions for that year, the commissioner shall973
	1016	+	not deny such desired contribution, but shall approve the proportional amount of the974
	1017	+	desired contribution up to the rural hospital organization's maximum allowed amount975
	1018	+	and any remainder shall be attributed as provided for in subparagraph (D) of this976
	1019	+	paragraph.977
	1020	+	(C)(D) In the event that an individual or corporate donor desires to make a contribution978
	1021	+	to an unspecified or undesignated rural hospital organization, either directly to the979
	1022	+	department or through a third party that participates in soliciting, administering, or980
	1023	+	managing donations, such donation shall be attributed to the rural hospital organization981
	1024	+	ranked with the highest financial need that has not yet received the maximum amount982
	1025	+	- 38 - 24 LC 33 9707S
	1026	+	of contributions for that taxable year, regardless of whether a third party has a983
	1027	+	contractual relationship or agreement with such rural hospital organization.984
	1028	+	(D)(E) Any third party that participates in soliciting, advertising, or managing985
	1029	+	donations shall provide the complete list of rural hospital organizations eligible to986
	1030	+	receive the tax credit provided pursuant to this Code section including their ranking in987
	1031	+	order of financial need as determined by the Department of Community Health988
	1032	+	pursuant to Code Section 31-8-9.1, to any potential donor regardless of whether a third989
	1033	+	party has a contractual relationship or agreement with such rural hospital organization.990
	1034	+	(3) For purposes of paragraphs (1) and (2) of this subsection, a rural hospital991
	1035	+	organization shall notify a potential donor of the requirements of this Code section. 992
	1036	+	Before making a contribution to a rural hospital organization, the taxpayer shall993
	1037	+	electronically notify the department, in a manner specified by the department, of the total994
	1038	+	amount of contribution that the taxpayer intends to make to the rural hospital995
	1039	+	organization. The commissioner shall preapprove or deny the requested amount or a996
	1040	+	portion of such amount, if applicable pursuant to subparagraph (C) of paragraph (2) of997
	1041	+	this subsection, within 30 days after receiving the request from the taxpayer and shall998
	1042	+	provide written notice to the taxpayer and rural hospital organization of such preapproval999
	1043	+	or denial which shall not require any signed release or notarized approval by the taxpayer. 1000
	1044	+	In order to receive a tax credit under this Code section, the taxpayer shall make the1001
	1045	+	contribution to the rural hospital organization within 180 days after receiving notice from1002
	1046	+	the department that the requested amount was preapproved. In order to receive a tax1003
	1047	+	credit under this Code section, a taxpayer preapproved by the commissioner on or before1004
	1048	+	September 30 shall make the contribution to the rural hospital organization within 1801005
	1049	+	days after receiving notice of preapproval from the commissioner, but not later than1006
	1050	+	October 31. A taxpayer preapproved by the commissioner after September 30 shall make1007
	1051	+	the contribution to the rural hospital organization on or before December 31. If the1008
	1052	+	taxpayer does not comply with this paragraph, the commissioner shall not include this1009
	1053	+	- 39 - 24 LC 33 9707S
	1054	+	preapproved contribution amount when calculating the limits prescribed in paragraphs1010
	1055	+	(1) and (2) of this subsection.1011
	1056	+	(4)(A) Preapproval of contributions by the commissioner shall be based solely on the1012
	1057	+	availability of tax credits subject to the aggregate total limit established under1013
	1058	+	paragraph (1) of this subsection and the individual rural hospital organization limit1014
	1059	+	established under paragraph (2) of this subsection.1015
	1060	+	(B) Any taxpayer preapproved by the department commissioner pursuant to this1016
	1061	+	subsection shall retain their approval in the event the credit percentage in this Code1017
	1062	+	section is modified for the year in which the taxpayer was preapproved.1018
	1063	+	(C) Upon the rural hospital organization's confirmation of receipt of donations that1019
	1064	+	have been preapproved by the department commissioner, any taxpayer preapproved by1020
	1065	+	the department commissioner pursuant to subsection (c) of this Code section shall1021
	1066	+	receive the full benefit of the income tax credit established by this Code section even1022
	1067	+	though the rural hospital organization to which the taxpayer made a donation does not1023
	1068	+	properly comply with the reports or filings required by this Code section.1024
	1069	+	(5) Notwithstanding any laws to the contrary, the department shall not take any adverse1025
	1070	+	action against donors to rural hospital organizations if the commissioner preapproved a1026
	1071	+	donation for a tax credit prior to the date the rural hospital organization is removed from1027
	1072	+	the Department of Community Health list pursuant to Code Section 31-8-9.1, and all such1028
	1073	+	donations shall remain as preapproved tax credits subject only to the donor's compliance1029
	1074	+	with paragraph (3) of this subsection."1030
	1075	+	"(k) This Code section shall stand automatically repealed and reserved on December 31,1031
	1076	+	2024 2029."1032
	1077	+	SECTION 12.1033
	1078	+	Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to1034
	1079	+	medical assistance generally, is amended by adding a new Code section to read as follows:1035
	1080	+	- 40 - 24 LC 33 9707S
	1081	+	"49-4-156.1036
	1082	+	(a) There is created the Comprehensive Health Coverage Commission. The commission1037
	1083	+	shall be attached to the Department of Community Health for administrative purposes only1038
	1084	+	as provided by Code Section 50-4-3.1039
	1085	+	(b) The commission shall consist of nine members, who shall be appointed no later than1040
	1086	+	July 1, 2024, as follows:1041
	1087	+	(1) The chairperson, who shall be a subject matter expert on health policy, and shall not1042
	1088	+	be an employee of the State of Georgia, to be appointed by the Governor;1043
	1089	+	(2) Three nonlegislative members to be appointed by the Speaker of the House of1044
	1090	+	Representatives;1045
	1091	+	(3) Three nonlegislative members to be appointed by the President of the Senate;1046
	1092	+	(4) One nonlegislative member to be appointed by the minority leader of the Senate; and1047
	1093	+	(5) One nonlegislative member to be appointed by the minority leader of the House of1048
	1094	+	Representatives.1049
	1095	+	(c) Members of the commission shall not be registered lobbyists in the State of Georgia.1050
	1096	+	(d) Members of the commission shall serve without compensation.1051
	1097	+	(e) The purpose of the commission shall be to advise the Governor, the General Assembly,1052
	1098	+	and the Department of Community Health, as the administrator of the state medical1053
	1099	+	assistance program, on issues related to access and quality of healthcare for Georgia's1054
	1100	+	low-income and uninsured populations. The commission shall be tasked with reviewing1055
	1101	+	the following:1056
	1102	+	(1) Opportunities related to reimbursement and funding for Georgia healthcare providers,1057
	1103	+	including premium assistance programs;1058
	1104	+	(2) Opportunities related to quality improvement of healthcare for Georgia's low income1059
	1105	+	and uninsured populations; and1060
	1106	+	(3) Opportunities to enhance service delivery and coordination of healthcare among and1061
	1107	+	across state agencies.1062
	1108	+	- 41 - 24 LC 33 9707S
	1109	+	(f) Subject to appropriations, the commission shall contract with experts and consultants1063
	1110	+	to produce a semiannual report on its findings for the Governor and the General Assembly. 1064
	1111	+	The commission shall provide its initial report to the Governor and the General Assembly1065
	1112	+	no later than December 1, 2024.1066
	1113	+	(g) The commission shall stand abolished on December 31, 2026, unless extended by the1067
	1114	+	General Assembly prior to such date."1068
	1115	+	SECTION 13.1069
	1116	+	(a) Sections 2, 8, 12, 13, and 14 of this Act shall become effective on July 1, 2024.1070
	1117	+	(b) Sections 1, 3, 4, 5 ,6, 7, and 9 of this Act shall become effective on July 1, 2025.1071
	1118	+	(c) Sections 10 and 11 of this Act shall be applicable to taxable years beginning on or after1072
	1119	+	January 1, 2024.1073
	1120	+	SECTION 14.1074
	1121	+	All laws and parts of laws in conflict with this Act are repealed.1075
	1122	+	- 42 -