Georgia Senate Bill SB162 Introduced / Bill

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Senate Bill 162
By: Senators Watson of the 1st, Dolezal of the 27th, Kirkpatrick of the 32nd, Brass of the
28th, Albers of the 56th and others 
A BILL TO BE ENTITLED
AN ACT
To amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to
1
eliminate certificate of need requirements for all health care facilities except certain2
long-term care facilities and services; to provide for a special health care services license for3
other health care facilities and services; to provide for definitions; to provide for4
requirements; to provide for exceptions; to provide for applications; to provide for notice and5
timely objections; to require the provision of indigent and charity care and Medicaid6
services; to provide for revocation; to require annual reports; to provide for rules and7
regulations; to provide for transition and grandfather provisions; to provide for the posting8
of certain documents on hospital websites; to amend Code Section 50-18-70 of the Official9
Code of Georgia Annotated, relating to legislative intent and definitions relative to open10
records laws, so as to revise definitions; to amend other provisions in various titles of the11
Official Code of Georgia Annotated for purposes of conformity; to provide for related12
matters; to provide for effective dates; to repeal conflicting laws; and for other purposes.13
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:14 23 LC 33 9350
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PART I
15
SECTION 1-1.16
Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by revising17
Chapter 6, relating to state health planning and development, as follows:18
"CHAPTER 619
ARTICLE 120
31-6-1.21
The policy of this state and the purposes of this chapter are to ensure access to quality22
health
 long-term care services and to ensure that long-term health care services and23
facilities are developed in an orderly and economical manner and are made available to all24
citizens and that only those long-term health care services found to be in the public interest25
shall be provided in this state.  To achieve such public policy and purposes, it is essential26
that appropriate health planning activities be undertaken and implemented and that a27
system of mandatory review of new institutional health services be provided.  Long-term28
health Health care services and facilities should be provided in a manner that avoids29
unnecessary duplication of services, that is cost effective, that provides quality health care30
services, and that is compatible with the long-term health care needs of the various areas31
and populations of the state.32
31-6-2.33
As used in this chapter, the term:34
(1)  'Ambulatory surgical center or obstetrical facility' means a public or private facility,35
not a part of a hospital, which provides surgical or obstetrical treatment performed under36 23 LC 33 9350
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general or regional anesthesia in an operating room environment to patients not requiring37
hospitalization.38
(2)(1) 'Application' means a written request for a certificate of need made to the39
department, containing such documentation and information as the department may40
require.41
(3)  'Basic perinatal services' means providing basic inpatient care for pregnant women42
and newborns without complications; managing perinatal emergencies; consulting with43
and referring to specialty and subspecialty hospitals; identifying high-risk pregnancies;44
providing follow-up care for new mothers and infants; and providing public/community45
education on perinatal health.46
(4)(2) 'Bed capacity' means space used exclusively for inpatient care, including space47
designed or remodeled for inpatient beds even though temporarily not used for such48
purposes.  The number of beds to be counted in any patient room shall be the maximum49
number for which adequate square footage is provided as established by rules of the50
department, except that single beds in single rooms shall be counted even if the room51
contains inadequate square footage.52
(5)(3) 'Board' means the Board of Community Health.53
(6)(4) 'Certificate of need' means an official finding by the department, evidenced by54
certification issued pursuant to an application, that the action proposed in the application55
satisfies and complies with the criteria contained in this chapter and rules promulgated56
pursuant hereto.57
(7)(5) 'Certificate of Need Appeal Panel' or 'appeal panel' means the panel of58
independent hearing officers created pursuant to Code Section 31-6-44 to conduct appeal59
hearings.60
(8)(6) 'Clinical health services' means diagnostic, treatment, or rehabilitative services61
provided in a health care facility and includes, but is not limited to, the following:62
radiology and diagnostic imaging, such as magnetic resonance imaging and positron63 23 LC 33 9350
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emission tomography (PET); radiation therapy; biliary lithotripsy; surgery; intensive care;64
coronary care; pediatrics; gynecology; obstetrics; general medical care; medical-surgical65
care; inpatient nursing care, whether intermediate, skilled, or extended care; cardiac66
catheterization; open heart surgery; inpatient rehabilitation; and alcohol, drug abuse, and67
mental health services.68
(9)(7) 'Commissioner' means the commissioner of community health.69
(10)  'Consumer' means a person who is not employed by any health care facility or70
provider and who has no financial or fiduciary interest in any health care facility or71
provider.72
(11)  Reserved.73
(12)(8) 'Department' means the Department of Community Health established under74
Chapter 2 of this title.75
(13)  'Destination cancer hospital' means an institution with a licensed bed capacity of 5076
or less which provides diagnostic, therapeutic, treatment, and rehabilitative care services77
to cancer inpatients and outpatients, by or under the supervision of physicians, and whose78
proposed annual patient base is composed of a minimum of 65 percent of patients who79
reside outside of the State of Georgia.80
(14)(9) 'Develop,' with reference to a project, means constructing, remodeling, installing,81
or proceeding with a project, or any part of a project, or a capital expenditure project, the82
cost estimate for which exceeds $10 million $3,068,601.00.  Notwithstanding the83
provisions of this paragraph, The dollar amount specified in this paragraph shall be84
adjusted annually by an amount calculated by the department to reflect inflation, which85
may be calculated by multiplying such dollar amount, as adjusted for the preceding year,86
by the annual percentage of change in the composite index of construction material87
prices, or its successor or appropriate replacement index, if any, published by the United88
States Department of Commerce for the preceding calendar year, commencing on89
July 1, 2023, and on each anniversary thereafter of the publication of the index.  The90 23 LC 33 9350
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department shall immediately institute rule-making procedures to adopt such adjusted91
dollar amounts.  In calculating the dollar amount of a proposed project for purposes of92
this paragraph, the costs of all items subject to review by this chapter and items not93
subject to review by this chapter associated with and simultaneously developed or94
proposed with the project shall be counted; provided, however, that the expenditure or95
commitment or incurring an obligation for the expenditure of funds to develop certificate96
of need applications, studies, reports, schematics, preliminary plans and specifications,97
or working drawings or to acquire, develop, or prepare sites shall not be considered to be98
the developing of a project.99
(15)  'Diagnostic imaging' means magnetic resonance imaging, computed tomography100
(CT) scanning, positron emission tomography (PET) scanning, positron emission101
tomography/computed tomography, and other advanced imaging services as defined by102
the department by rule, but such term shall not include X-rays, fluoroscopy, or ultrasound103
services.104
(16)  'Diagnostic, treatment, or rehabilitation center' means any professional or business105
undertaking, whether for profit or not for profit, which offers or proposes to offer any106
clinical health service in a setting which is not part of a hospital; provided, however, that107
any such diagnostic, treatment, or rehabilitation center that offers or proposes to offer108
surgery in an operating room environment and to allow patients to remain more than 23109
hours shall be considered a hospital for purposes of this chapter.110
(16.1)  'General cancer hospital' means an institution which was an existing and approved111
destination cancer hospital as of January 1, 2019; has obtained final certificate of need112
approval for conversion from a destination cancer hospital to a general cancer hospital113
in accordance with Code Section 31-6-40.3; and offers inpatient and outpatient114
diagnostic, therapeutic, treatment, and rehabilitative cancer care services or other services115
to diagnose or treat co-morbid medical conditions or diseases of cancer patients so long116
as such services do not result in the offering of any new or expanded clinical health117 23 LC 33 9350
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service that would require a certificate of need under this chapter unless a certificate of118
need or letter of determination has been obtained for such new or expanded services.119
(17)(10) 'Health care facility' means hospitals; destination cancer hospitals; other special120
care units, including but not limited to podiatric facilities; skilled nursing facilities;121
intermediate care facilities; personal care homes; ambulatory surgical centers or122
obstetrical facilities; freestanding emergency departments or facilities not located on a123
hospital's primary campus; health maintenance organizations; and home health agencies;124
and diagnostic, treatment, or rehabilitation centers, but only to the extent paragraph (3)125
or (7), or both paragraphs (3) and (7), of subsection (a) of Code Section 31-6-40 are126
applicable thereto.127
(18)  'Health maintenance organization' means a public or private organization organized128
under the laws of this state which:129
(A)  Provides or otherwise makes available to enrolled participants health care services,130
including at least the following basic health care services: usual physicians' services,131
hospitalization, laboratory, X-ray, emergency and preventive services, and out-of-area132
coverage;133
(B)  Is compensated, except for copayments, for the provision of the basic health care134
services listed in subparagraph (A) of this paragraph to enrolled participants on a135
predetermined periodic rate basis; and136
(C)  Provides physicians' services primarily:137
(i)  Directly through physicians who are either employees or partners of such138
organization; or139
(ii)  Through arrangements with individual physicians organized on a group practice140
or individual practice basis.141
(19)  'Health Strategies Council' or 'council' means the body created by this chapter to142
advise the department.143 23 LC 33 9350
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(20)(11) 'Home health agency' means a public agency or private organization, or a144
subdivision of such an agency or organization, which is primarily engaged in providing145
to individuals who are under a written plan of care of a physician, on a visiting basis in146
the places of residence used as such individuals' homes, part-time or intermittent nursing147
care provided by or under the supervision of a registered professional nurse, and one or148
more of the following services:149
(A)  Physical therapy;150
(B)  Occupational therapy;151
(C)  Speech therapy;152
(D)  Medical social services under the direction of a physician; or153
(E)  Part-time or intermittent services of a home health aide.154
(21)  'Hospital' means an institution which is primarily engaged in providing to inpatients,155
by or under the supervision of physicians, diagnostic services and therapeutic services for156
medical diagnosis, treatment, and care of injured, disabled, or sick persons or157
rehabilitation services for the rehabilitation of injured, disabled, or sick persons.  Such158
term includes public, private, psychiatric, rehabilitative, geriatric, osteopathic,159
micro-hospitals, general cancer hospitals, and other specialty hospitals.160
(22)(12) 'Intermediate care facility' means an institution which provides, on a regular161
basis, health related care and services to individuals who do not require the degree of care162
and treatment which a hospital or skilled nursing facility is designed to provide but who,163
because of their mental or physical condition, require health related care and services164
beyond the provision of room and board.165
(23)  'Joint venture ambulatory surgical center' means a freestanding ambulatory surgical166
center that is jointly owned by a hospital in the same county as the center or a hospital in167
a contiguous county if there is no hospital in the same county as the center and a single168
group of physicians practicing in the center and that provides surgery in a single specialty169
as defined by the department; provided, however, that general surgery, a group practice170 23 LC 33 9350
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which includes one or more physiatrists who perform services that are reasonably related171
to the surgical procedures performed in the center, and a group practice in orthopedics172
which includes plastic hand surgeons with a certificate of added qualifications in Surgery173
of the Hand from the American Board of Plastic and Reconstructive Surgery shall be174
considered a single specialty.  The ownership interest of the hospital shall be no less than175
30 percent and the collective ownership of the physicians or group of physicians shall be176
no less than 30 percent.177
(23.1)(13) 'Life plan community' means an organization, whether operated for profit or178
not, whose owner or operator undertakes to provide shelter, food, and either nursing care179
or personal services, whether such nursing care or personal services are provided in the180
facility or in another setting, and other services, as designated by agreement, to an181
individual not related by consanguinity or affinity to such owner or operator providing182
such care pursuant to an agreement for a fixed or variable fee, or for any other183
remuneration of any type, whether fixed or variable, for the period of care, payable in a184
lump sum, lump sum and monthly maintenance charges or in installments.  Agreements185
to provide continuing care include agreements to provide care for any duration, including186
agreements that are terminable by either party.187
(23.2)  'Micro-hospital' means a hospital in a rural county which has at least two and not188
more than seven inpatient beds and which provides emergency services seven days per189
week and 24 hours per day.190
(24)  'New and emerging health care service' means a health care service or utilization of191
medical equipment which has been developed and has become acceptable or available for192
implementation or use but which has not yet been addressed under the rules and193
regulations promulgated by the department pursuant to this chapter.194
(25)  'Nonclinical health services' means services or functions provided or performed by195
a health care facility, and the parts of the physical plant where they are located in a health196 23 LC 33 9350
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care facility that are not diagnostic, therapeutic, or rehabilitative services to patients and197
are not clinical health services defined in this chapter.198
(26)(14) 'Offer' means that the health care facility is open for the acceptance of patients199
or performance of services and has qualified personnel, equipment, and supplies200
necessary to provide specified clinical health services.201
(27)  'Operating room environment' means an environment which meets the minimum202
physical plant and operational standards specified in the rules of the department which203
shall consider and use the design and construction specifications as set forth in the204
Guidelines for Design and Construction of Health Care Facilities published by the205
American Institute of Architects.206
(28)  'Pediatric cardiac catheterization' means the performance of angiographic,207
physiologic, and, as appropriate, therapeutic cardiac catheterization on children 14 years208
of age or younger.209
(29)(15) 'Person' means any individual, trust or estate, partnership, limited liability210
company or partnership, corporation (including associations, joint-stock companies, and211
insurance companies), state, political subdivision, hospital authority, or instrumentality212
(including a municipal corporation) of a state as defined in the laws of this state.  This213
term shall include all related parties, including individuals, business corporations, general214
partnerships, limited partnerships, limited liability companies, limited liability215
partnerships, joint ventures, nonprofit corporations, or any other for profit or not for profit216
entity that owns or controls, is owned or controlled by, or operates under common217
ownership or control with a person.218
(30)(16) 'Personal care home' means a residential facility that is certified as a provider219
of medical assistance for Medicaid purposes pursuant to Article 7 of Chapter 4 of Title220
49 having at least 25 beds and providing, for compensation, protective care and oversight221
of ambulatory, nonrelated persons who need a monitored environment but who do not222
have injuries or disabilities which require chronic or convalescent care, including223 23 LC 33 9350
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medical, nursing, or intermediate care.  Personal care homes include those facilities
224
which monitor daily residents' functioning and location, have the capability for crisis225
intervention, and provide supervision in areas of nutrition, medication, and provision of226
transient medical care.  Such term does not include:227
(A)  Old age residences which are devoted to independent living units with kitchen228
facilities in which residents have the option of preparing and serving some or all of their229
own meals; or230
(B)  Boarding facilities which do not provide personal care.231
(30.1)  'Primary campus' means the building at which the majority of a hospital's or a
232
remote location of a hospital's licensed and operational inpatient hospital beds are233
located, and includes the health care facilities of such hospital within 1,000 yards of such234
building.  Any health care facility operated under a hospital's license prior to July 1, 2019,235
but not on the hospital's primary campus shall remain part of such hospital but shall not236
constitute such hospital's primary campus unless otherwise meeting the requirements of237
this paragraph.238
(31)(17) 'Project' means a proposal to take an action for which a certificate of need is239
required under this chapter.  A project or proposed project may refer to the proposal from240
its earliest planning stages up through the point at which the new institutional health241
service is offered.242
(31.1)  'Remote location of a hospital' means a hospital facility or organization that is243
either created by, or acquired by, a hospital that is the main provider for the purpose of244
furnishing inpatient hospital services under the name, ownership, and financial and245
administrative control of the main provider.246
(32)  'Rural county' means a county having a population of less than 50,000 according to247
the United States decennial census of 2010 or any future such census.248
(33)  'Single specialty ambulatory surgical center' means an ambulatory surgical center249
where surgery is performed in the offices of an individual private physician or single250 23 LC 33 9350
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group practice of private physicians if such surgery is performed in a facility that is251
owned, operated, and utilized by such physicians who also are of a single specialty;252
provided, however, that general surgery, a group practice which includes one or more253
physiatrists who perform services that are reasonably related to the surgical procedures254
performed in the center, and a group practice in orthopedics which includes plastic hand255
surgeons with a certificate of added qualifications in Surgery of the Hand from the256
American Board of Plastic and Reconstructive Surgery shall be considered a single257
specialty.258
(34)(18) 'Skilled nursing facility' means a public or private institution or a distinct part259
of an institution which is primarily engaged in providing inpatient skilled nursing care260
and related services for patients who require medical or nursing care or rehabilitation261
services for the rehabilitation of injured, disabled, or sick persons.262
(35)  'Specialty hospital' means a hospital that is primarily or exclusively engaged in the263
care and treatment of one of the following: patients with a cardiac condition, patients with264
an orthopedic condition, patients receiving a surgical procedure, or patients receiving any265
other specialized category of services defined by the department.  A 'specialty hospital'266
does not include a destination cancer hospital or a general cancer hospital.267
(36)(19) 'State health plan' means a comprehensive program based on recommendations268
by the Health Strategies Council and the board, approved by the Governor, and269
implemented by the State of Georgia for the purpose of providing adequate long-term270
health care services and facilities throughout the state.271
(37)(20) 'Uncompensated indigent or charity care' means the dollar amount of 'net272
uncompensated indigent or charity care after direct and indirect (all) compensation' as273
defined by, and calculated in accordance with, the department's Hospital Financial Survey274
and related instructions.275
(38)  'Urban county' means a county having a population equal to or greater than 50,000276
according to the United States decennial census of 2010 or any future such census.277 23 LC 33 9350
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31-6-3.278
(a)  As used in this Code section, the term 'medical use rights' means rights or interests in279
real property in which the owner of the property has agreed not to sell or lease such real280
property for identified medical uses or purposes.281
(b)  It shall be unlawful for any health care facility to purchase, renew, extend, lease,282
maintain, or hold medical use rights.283
(c)  This Code section shall not be construed to impair any contracts in existence as of July284
1, 2019.285
ARTICLE 2286
31-6-20.287
Reserved.288
31-6-21.289
(a)  The Department of Community Health, established under Chapter 2 of this title, is290
authorized to administer the certificate of need program established under this chapter and,291
within the appropriations made available to the department by the General Assembly of292
Georgia and consistently with the laws of the State of Georgia, a state health plan adopted293
by the board.  The department shall provide, by rule, for procedures to administer its294
functions until otherwise provided by the board.295
(b)  The functions of the department shall be:296
(1)  To conduct the health planning activities of the state and to implement those parts of297
the state health plan which relate to the government of the state;298
(2)  To prepare and revise a draft state health plan with recommendations from technical299
advisory committees;300 23 LC 33 9350
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(3)  To seek advice, at its discretion, from technical advisory committees in the301
performance by the department of its functions pursuant to this chapter;302
(4)(3) To adopt, promulgate, and implement rules and regulations sufficient to administer303
the provisions of this chapter including the certificate of need program;304
(5)(4) To define, by rule, the form, content, schedules, and procedures for submission305
of applications for certificates of need, other determinations, and periodic reports;306
(6)(5) To establish time periods and procedures consistent with this chapter to hold307
hearings and to obtain the viewpoints of interested persons prior to issuance or denial of308
a certificate of need;309
(7)(6) To provide, by rule, for such fees as may be necessary to cover the costs of310
hearing officers, preparing the record for appeals before such hearing officers and the311
Certificate of Need Appeal Panel of the decisions of the department, and other related312
administrative costs, which costs may include reasonable sharing between the department313
and the parties to appeal hearings;314
(8)(7) To establish, by rule, need methodologies for new institutional health services and315
health care facilities.  In developing such need methodologies, the department shall, at316
a minimum, consider the demographic characteristics of the population, the health status317
of the population, service use patterns, standards and trends, financial and geographic318
accessibility, and market economics.  The department shall establish service-specific need319
methodologies and criteria for at least the following clinical health services: short stay320
hospital beds, adult therapeutic cardiac catheterization, adult open heart surgery, pediatric321
cardiac catheterization and open heart surgery, Level II and III perinatal services,322
freestanding birthing centers, psychiatric and substance abuse inpatient programs, skilled323
nursing and intermediate care facilities, home health agencies, and life plan community324
sheltered facilities;325 23 LC 33 9350
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(9)(8) To provide, by rule, for a reasonable and equitable fee schedule for certificate of326
need applications; provided, however, that a certificate of need application filed by or on327
behalf of a hospital in a rural county shall be exempt from any such fee;328
(10)(9) To grant, deny, or revoke a certificate of need as applied for or as amended; and329
(11)(10) To perform powers and functions delegated by the Governor, which delegation330
may include the powers to carry out the duties and powers which have been delegated to331
the department under Section 1122 of the federal Social Security Act of 1935, as332
amended; and333
(12)  Study the amount of uncompensated indigent and charity care provided by each type334
of health care facility, recommend requirements for the levels of uncompensated indigent335
and charity care required to be performed by each health care facility type and develop336
standardized reporting requirements for the department to accurately track the amount of337
uncompensated indigent and charity care provided by each health care facility.338
(c)  The commissioner shall have the power to establish and abolish technical advisory339
committees as he or she deems necessary, in consultation with the board, to inform340
effective strategy development and execution.341
31-6-21.1.342
(a)  Rules of the department shall be adopted, promulgated, and implemented as provided343
in this Code section and in Chapter 13 of Title 50, the 'Georgia Administrative Procedure344
Act,' except that the department shall not be required to comply with subsections (c)345
through (g) of Code Section 50-13-4.346
(b)  The department shall transmit three copies of the notice provided for in paragraph (1)347
of subsection (a) of Code Section 50-13-4 to the legislative counsel.  The copies shall be348
transmitted at least 30 days prior to that department's intended action.  Within five days349
after receipt of the copies, if possible, the legislative counsel shall furnish the presiding350
officer of each house with a copy of the notice and mail a copy of the notice to each351 23 LC 33 9350
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member of the Senate Health and Human Services Committee of the Senate and each352
member of the House Committee on Health and Human Services Committee of the House353
of Representatives.  Each such rule and any part thereof shall be subject to the making of354
an objection by either such committee within 30 days of transmission of the rule to the355
members of such committee.  Any rule or part thereof to which no objection is made by356
both such committees may become adopted by the department at the end of such 30 day357
period.  The department may not adopt any such rule or part thereof which has been358
changed since having been submitted to those committees unless:359
(1)  That change is to correct only typographical errors;360
(2)  That change is approved in writing by both committees and that approval expressly361
exempts that change from being subject to the public notice and hearing requirements of362
subsection (a) of Code Section 50-13-4;363
(3)  That change is approved in writing by both committees and is again subject to the364
public notice and hearing requirements of subsection (a) of Code Section 50-13-4; or365
(4)  That change is again subject to the public notice and hearing requirements of366
subsection (a) of Code Section 50-13-4 and the change is submitted and again subject to367
committee objection as provided in this subsection.368
Nothing in this subsection shall prohibit the department from adopting any rule or part369
thereof without adopting all of the rules submitted to the committees if the rule or part so370
adopted has not been changed since having been submitted to the committees and objection371
thereto was not made by both committees.372
(c)  Any rule or part thereof to which an objection is made by both committees within the373
30 day objection period under subsection (b) of this Code section shall not be adopted by374
the department and shall be invalid if so adopted.  A rule or part thereof thus prohibited375
from being adopted shall be deemed to have been withdrawn by the department unless the376
department, within the first 15 days of the next regular session of the General Assembly,377
transmits written notification to each member of the objecting committees that the378 23 LC 33 9350
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department does not intend to withdraw that rule or part thereof but intends to adopt the
379
specified rule or part effective the day following adjournment sine die of that regular380
session.  A resolution objecting to such intended adoption may be introduced in either381
branch of the General Assembly after the fifteenth day but before the thirtieth day of the382
session in which occurs the notification of intent not to withdraw a rule or part thereof.  In383
the event the resolution is adopted by the branch of the General Assembly in which the384
resolution was introduced, it shall be immediately transmitted to the other branch of the385
General Assembly.  It shall be the duty of the presiding officer of the other branch to have386
that branch, within five days after receipt of the resolution, consider the resolution for387
purposes of objecting to the intended adoption of the rule or part thereof.  Upon such388
resolution being adopted by two-thirds of the vote of each branch of the General Assembly,389
the rule or part thereof objected to in that resolution shall be disapproved and not adopted390
by the department.  If the resolution is adopted by a majority but by less than two-thirds of391
the vote of each such branch, the resolution shall be submitted to the Governor for his or392
her approval or veto.  In the event of a veto, or if no resolution is introduced objecting to393
the rule, or if the resolution introduced is not approved by at least a majority of the vote of394
each such branch, the rule shall automatically become adopted the day following395
adjournment sine die of that regular session.  In the event of the Governor's approval of the396
resolution, the rule shall be disapproved and not adopted by the department.397
(d)  Any rule or part thereof which is objected to by only one committee under398
subsection (b) of this Code section and which is adopted by the department may be399
considered by the branch of the General Assembly whose committee objected to its400
adoption by the introduction of a resolution for the purpose of overriding the rule at any401
time within the first 30 days of the next regular session of the General Assembly.  It shall402
be the duty of the department in adopting a proposed rule over such objection so to notify403
the chairpersons of the Senate
 Health and Human Services Committee of the Senate and404
the House Committee on Health and Human Services Committee of the House within ten405 23 LC 33 9350
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days after the adoption of the rule.  In the event the resolution is adopted by such branch
406
of the General Assembly, it shall be immediately transmitted to the other branch of the407
General Assembly.  It shall be the duty of the presiding officer of the other branch of the408
General Assembly to have such branch, within five days after the receipt of the resolution,409
consider the resolution for the purpose of overriding the rule.  In the event the resolution410
is adopted by two-thirds of the votes of each branch of the General Assembly, the rule shall411
be void on the day after the adoption of the resolution by the second branch of the General412
Assembly.  In the event the resolution is ratified by a majority but by less than two-thirds413
of the votes of either branch, the resolution shall be submitted to the Governor for his or414
her approval or veto.  In the event of a veto, the rule shall remain in effect.  In the event of415
the Governor's approval, the rule shall be void on the day after the date of approval.416
(e)  Except for emergency rules, no rule or part thereof adopted by the department after417
April 3, 1985, shall be valid unless adopted in compliance with subsections (b), (c), and (d)418
of this Code section and subsection (a) of Code Section 50-13-4.419
(f)  Emergency rules shall not be subject to the requirements of subsection (b), (c), or (d)420
of this Code section but shall be subject to the requirements of subsection (b) of Code421
Section 50-13-4.  Upon the first expiration of any department emergency rules, where
 when422
those emergency rules are intended to cover matters which had been dealt with by the423
department's nonemergency rules but such nonemergency rules have been objected to by424
both legislative committees under this Code section, the emergency rules concerning those425
matters may not again be adopted except for one 120 day period.  No emergency rule or426
part thereof which is adopted by the department shall be valid unless adopted in427
compliance with this subsection.428
(g)  Any proceeding to contest any rule on the ground of noncompliance with this Code429
section must be commenced within two years from the effective date of the rule.430
(h)  For purposes of this Code section, the term 'rules' shall mean rules and regulations.431 23 LC 33 9350
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(i)  The state health plan or the rules establishing considerations, standards, or similar
432
criteria for the grant or denial of a certificate of need pursuant to Code Section 31-6-42433
shall not apply to any application for a certificate of need as to which, prior to the effective434
date of such plan or rules, respectively, the evidence has been closed following a full435
evidentiary hearing before a hearing officer.436
(j)  This Code section shall apply only to rules adopted pursuant to this chapter.437
ARTICLE 3438
31-6-40.439
(a)  On and after July 1, 2008, any new institutional health service shall be required to440
obtain a certificate of need pursuant to this chapter.  New institutional health services441
include:442
(1)  The construction, development, or other establishment of a new, expanded, or443
relocated health care facility, except as otherwise provided in Code Section 31-6-47;444
(2)  Any expenditure by or on behalf of a health care facility in excess of $10 million
445
which, under generally accepted accounting principles consistently applied, is a capital446
expenditure, except expenditures for acquisition of an existing health care facility.  The447
dollar amounts specified in this paragraph and in paragraph (14) of Code Section 31-6-2448
shall be adjusted annually by an amount calculated by multiplying such dollar amounts449
(as adjusted for the preceding year) by the annual percentage of change in the composite450
index of construction material prices, or its successor or appropriate replacement index,451
if any, published by the United States Department of Commerce for the preceding452
calendar year, commencing on July 1, 2019, and on each anniversary thereafter of453
publication of the index.  The department shall immediately institute rule-making454
procedures to adopt such adjusted dollar amounts.  In calculating the dollar amounts of455
a proposed project for purposes of this paragraph and paragraph (14) of Code Section456 23 LC 33 9350
S. B. 162
- 19 -
31-6-2, the costs of all items subject to review by this chapter and items not subject to457
review by this chapter associated with and simultaneously developed or proposed with458
the project shall be counted, except for the expenditure or commitment of or incurring an459
obligation for the expenditure of funds to develop certificate of need applications, studies,460
reports, schematics, preliminary plans and specifications or working drawings, or to461
acquire sites;462
(3)  The purchase or lease by or on behalf of a health care facility or a diagnostic,463
treatment, or rehabilitation center of diagnostic or therapeutic equipment, except as464
otherwise provided in Code Section 31-6-47;465
(4)(2) Any increase in the bed capacity of a health care facility except as provided in466
Code Section 31-6-47; and467
(5)(3) Clinical health services which are offered in or through a health care facility,468
which were not offered on a regular basis in or through such health care facility within469
the 12 month period prior to the time such services would be offered;.470
(6)  Any conversion or upgrading of any general acute care hospital to a specialty hospital471
or of a facility such that it is converted from a type of facility not covered by this chapter472
to any of the types of health care facilities which are covered by this chapter;473
(7)  Clinical health services which are offered in or through a diagnostic, treatment, or474
rehabilitation center which were not offered on a regular basis in or through that center475
within the 12 month period prior to the time such services would be offered, but only if476
the clinical health services are any of the following:477
(A)  Radiation therapy;478
(B)  Biliary lithotripsy;479
(C)  Surgery in an operating room environment, including but not limited to ambulatory480
surgery; and481
(D)  Cardiac catheterization; and482
(8)  The conversion of a destination cancer hospital to a general cancer hospital.483 23 LC 33 9350
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(b)  Any person proposing to develop or offer a new institutional health service or health
484
care facility shall, before commencing such activity, submit a letter of intent and an485
application to the department and obtain a certificate of need in the manner provided in this486
chapter unless such activity is excluded from the scope of this chapter.487
(c)(1)
  Any person who had a valid exemption granted or approved by the former Health488
Planning Agency or the department prior to July 1, 2008, shall not be required to obtain489
a certificate of need in order to continue to offer those previously offered services.490
(2)  Any facility offering ambulatory surgery pursuant to the exclusion designated on491
June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2; any diagnostic, treatment,492
or rehabilitation center offering diagnostic imaging or other imaging services in operation493
and exempt prior to July 1, 2008; or any facility operating pursuant to a letter of494
nonreviewability  and offering diagnostic imaging services prior to July 1, 2008, shall:495
(A)  Provide annual reports in the same manner and in accordance with Code Section496
31-6-70; and497
(B)(i)  Provide care to Medicaid beneficiaries and, if the facility provides medical care498
and treatment to children, to PeachCare for Kids beneficiaries and provide499
uncompensated indigent and charity care in an amount equal to or greater than 2500
percent of its adjusted gross revenue; or501
(ii)  If the facility is not a participant in Medicaid or the PeachCare for Kids Program,502
provide uncompensated care for Medicaid beneficiaries and, if the facility provides503
medical care and treatment to children, for PeachCare for Kids beneficiaries,504
uncompensated indigent and charity care, or both in an amount equal to or greater505
than 4 percent of its adjusted gross revenue if it:506
(I)  Makes a capital expenditure associated with the construction, development,507
expansion, or other establishment of a clinical health service or the acquisition or508
replacement of diagnostic or therapeutic equipment with a value in excess of509
$800,000.00 over a two-year period;510 23 LC 33 9350
S. B. 162
- 21 -
(II)  Builds a new operating room; or511
(III)  Chooses to relocate in accordance with Code Section 31-6-47.512
Noncompliance with any condition of this paragraph shall result in a monetary penalty513
in the amount of the difference between the services which the center is required to514
provide and the amount actually provided and may be subject to revocation of its515
exemption status by the department for repeated failure to pay any fees or moneys due516
to the department or for repeated failure to produce data as required by Code Section517
31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of518
Title 50, the 'Georgia Administrative Procedure Act.'  The dollar amount specified in this519
paragraph shall be adjusted annually by an amount calculated by multiplying such dollar520
amount (as adjusted for the preceding year) by the annual percentage of change in the521
consumer price index, or its successor or appropriate replacement index, if any, published522
by the United States Department of Labor for the preceding calendar year, commencing523
on July 1, 2009.  In calculating the dollar amounts of a proposed project for the purposes524
of this paragraph, the costs of all items subject to review by this chapter and items not525
subject to review by this chapter associated with and simultaneously developed or526
proposed with the project shall be counted, except for the expenditure or commitment of527
or incurring an obligation for the expenditure of funds to develop certificate of need528
applications, studies, reports, schematics, preliminary plans and specifications or working529
drawings, or to acquire sites.  Subparagraph (B) of this paragraph shall not apply to530
facilities offering ophthalmic ambulatory surgery pursuant to the exclusion designated531
on June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2 that are owned by532
physicians in the practice of ophthalmology.533
(d)  A certificate of need issued to a destination cancer hospital shall authorize the beds and534
all new institutional health services of such destination cancer hospital.  As used in this535
subsection, the term 'new institutional health service' shall have the same meaning provided536
for in subsection (a) of this Code section.  A certificate of need shall only be issued to a537 23 LC 33 9350
S. B. 162
- 22 -
destination cancer hospital that locates itself and all affiliated facilities within 25 miles of538
a commercial airport in this state with five or more runways.  Such destination cancer539
hospital shall not be required to apply for or obtain additional certificates of need for new540
institutional health services related to the treatment of cancer patients, and such new541
institutional health services related to the treatment of cancer patients offered by the542
destination cancer hospital shall not be reviewed under any service-specific need543
methodology or rules except for those promulgated by the department for destination544
cancer hospitals.  After commencing operations, in order to add an additional new545
institutional health service, a destination cancer hospital shall apply for and obtain an546
additional certificate of need under the applicable statutory provisions and any rules547
promulgated by the department for destination cancer hospitals,  and such applications shall548
only be granted if the patient base of such destination cancer hospital is composed of at549
least 65 percent of out-of-state patients for two consecutive years.  The department may550
apply rules for a destination cancer hospital only for those services that the department551
determines are to be used by the destination cancer hospital in connection with the552
treatment of cancer.  In no case shall destination cancer hospital specific rules be used in553
the case of an application for open heart surgery, perinatal services, cardiac catheterization,554
and other services deemed by the department to be not reasonably related to the diagnosis555
and treatment of cancer; provided, however, that the department shall apply the destination556
cancer hospital specific rules if a destination cancer hospital applies for services and557
equipment required for it to meet federal or state laws applicable to a hospital.  If such558
destination cancer hospital cannot show a patient base of a minimum of 65 percent from559
outside of this state, then its application for any new institutional health service shall be560
evaluated under the specific statutes and rules applicable to that particular service.  If such561
destination cancer hospital applies for a certificate of need to add an additional new562
institutional health service before commencing operations or completing two consecutive563
years of operation, such applicant may rely on historical data from its affiliated entities, as564 23 LC 33 9350
S. B. 162
- 23 -
set forth in paragraph (2) of subsection (b.1) of Code Section 31-6-42.  Because destination565
cancer hospitals provide services primarily to out-of-state residents, the number of beds,566
services, and equipment destination cancer hospitals use shall not be counted as part of the567
department's inventory when determining the need for those items by other providers.  No568
person shall be issued more than one certificate of need for a destination cancer hospital.569
Nothing in this Code section shall in any way require a destination cancer hospital to obtain570
a certificate of need for any purpose that is otherwise exempt from the certificate of need571
requirement.  Beginning January 1, 2010, the department shall not accept any application572
for a certificate of need for a new destination cancer hospital; provided, however, all other573
provisions regarding the upgrading, replacing, or purchasing of diagnostic or therapeutic574
equipment shall be applicable to an existing destination cancer hospital.575
(e)  The commissioner shall be authorized, with the approval of the board, to place a576
temporary moratorium of up to six months on the issuance of certificates of need for new577
and emerging health care services.  Any such moratorium placed shall be for the purpose578
of promulgating rules and regulations regarding such new and emerging health care579
services.  A moratorium may be extended one time for an additional three months if580
circumstances warrant, as approved by the board.  In the event that final rules and581
regulations are not promulgated within the time period allowed by the moratorium, any582
applications received by the department for a new and emerging health care service shall583
be reviewed under existing general statutes and regulations relating to certificates of need.584
31-6-40.1.585
(a)  Any person who acquires a health care facility by stock or asset purchase, merger,586
consolidation, or other lawful means shall notify the department of such acquisition, the587
date thereof, and the name and address of the acquiring person.  Such notification shall be588
made in writing to the department within 45 days following the acquisition and the589 23 LC 33 9350
S. B. 162
- 24 -
acquiring person may be fined by the department in the amount of $500.00 for each day
590
that such notification is late.  Such fine shall be paid into the state treasury.591
(b)  The department may limit the time periods during which it will accept applications for592
the following health care facilities:593
(1)  Skilled nursing facilities;594
(2)  Intermediate care facilities; and595
(3)  Home health agencies,596
to only such times after the department has determined there is an unmet need for such597
facilities.  The department shall make a determination as to whether or not there is an598
unmet need for each type of facility at least every six months and shall notify those599
requesting such notification of that determination.600
(c)  The department may require that any applicant for a certificate of need agree to provide601
a specified amount of clinical health services to indigent patients as a condition for the602
grant of a certificate of need; provided, however, that each facility granted a certificate of
603
need by the department as a destination cancer hospital shall be required to provide604
uncompensated indigent or charity care for residents of Georgia which meets or exceeds605
3 percent of such destination cancer hospital's adjusted gross revenues and provide care to606
Medicaid beneficiaries.  A grantee or successor in interest of a certificate of need or an607
authorization to operate under this chapter which violates such an agreement or violates608
any conditions imposed by the department relating to such services, whether made before609
or after July 1, 2008, shall be liable to the department for a monetary penalty in the amount610
of the difference between the amount of services so agreed to be provided and the amount611
actually provided and may be subject to revocation of its certificate of need, in whole or612
in part, by the department pursuant to Code Section 31-6-45.  Any penalty so recovered613
shall be paid into the state treasury.614
(c.1)(1)  A destination cancer hospital that does not meet an annual patient base615
composed of a minimum of 65 percent of patients who reside outside this state in a616 23 LC 33 9350
S. B. 162
- 25 -
calendar year shall be fined $2 million for the first year of noncompliance, $4 million for617
the second consecutive year of noncompliance, and $6 million for the third consecutive618
year of noncompliance.  Such fine amount shall reset to $2 million after any year of619
compliance.  In the event that a destination cancer hospital does not meet an annual620
patient base composed of a minimum of 65 percent of patients who reside outside this621
state for three calendar years in any five-year period, such hospital shall be fined an622
additional amount of $8 million.  It is the intent of the General Assembly that all revenues623
collected from any such fines shall be dedicated and deposited by the department into the624
Indigent Care Trust Fund created pursuant to Code Section 31-8-152.625
(2)  In the event a certificate of need for a destination cancer hospital is revoked pursuant626
to this subsection, such hospital shall be subject to fines pursuant to subsection (c) of627
Code Section 31-6-45 for operating without a certificate of need.628
(3)  In addition to the annual report required pursuant to Code Section 31-6-70, a629
destination cancer hospital shall submit an annual statement, in accordance with630
timeframes and a format specified by the department, affirming that the hospital has met631
an annual patient base composed of a minimum of 65 percent of patients who reside632
outside this state.  The chief executive officer of the destination cancer hospital shall633
certify under penalties of perjury that the statement as prepared accurately reflects the634
composition of the annual patient base.  The department shall have the authority to635
inspect any books, records, papers, or other information pursuant to subsection (e) of636
Code Section 31-6-45 of the destination cancer hospital to confirm the information637
provided on such statement or any other information required of the destination cancer638
hospital.  Nothing in this paragraph shall be construed to require the release of any639
information which would violate the Health Insurance Portability and Accountability Act640
of 1996, P.L. 104-191.641
(d)  Penalties authorized under this Code section shall be subject to the same notices and642
hearing for the levy of fines under Code Section 31-6-45.643 23 LC 33 9350
S. B. 162
- 26 -
31-6-40.2.644
(a)  As used in this Code section only, the term:645
(1)  'Certificate of need application' means an application for a certificate of need filed646
with the department, any amendments thereto, and any other written material relating to647
the application and filed by the applicant with the department.648
(2)  'First three years of operation' means the first three consecutive 12 month periods649
beginning on the first day of a new perinatal service's first full calendar month of650
operation.651
(3)  'First year of operation' means the first consecutive 12 month period beginning on the652
first day of a new perinatal service's first full calendar month of operation.653
(4)  'New perinatal service' means a perinatal service whose first year of operation ends654
after April 6, 1992.655
(5)  'Perinatal service' means obstetric and neonatal services relating to managing656
high-risk pregnancies, care for moderately ill newborns, care for all maternal and fetal657
complications either on site or by referral, and operation of neonatal intensive care units658
equipped to treat critically ill newborns; provided however, this shall not include basic659
perinatal services as defined in Code Section 31-6-2.660
(6)  'Year' means one of the three consecutive 12 month periods in a new perinatal661
service's first 36 months of operation.662
(b)(1)  A new perinatal service shall provide uncompensated indigent or charity care in663
an amount which meets or exceeds the department's established minimum at the time the664
department issued the certificate of need approval for such service for each of the665
service's first three years of operation; provided, however, that if the certificate of need666
application under which a new perinatal service was approved included a commitment667
that uncompensated indigent or charity care would be provided in an amount greater than668
the established minimum for any time period described in the certificate of need669
application that falls completely within such new perinatal service's first three years of670 23 LC 33 9350
S. B. 162
- 27 -
operation, such new perinatal service shall provide indigent or charity care in an amount671
which meets or exceeds the amount committed in the certificate of need application for672
each time period described in the certificate of need application that falls completely673
within the service's first three years of operation.674
(2)  The department shall revoke the certificate of need and authority to operate of a new675
perinatal service if after notice to the grantee of the certificate or such grantee's676
successors, and after opportunity for a fair hearing pursuant to Chapter 13 of Title 50, the677
'Georgia Administrative Procedure Act,' the department determines that such new678
perinatal service has failed to provide indigent or charity care in accordance with the679
requirements of paragraph (1) of this subsection and such failure is determined by the680
department to be for reasons substantially within the perinatal service provider's control.681
The department shall provide the requisite notice, conduct the fair hearing, if requested,682
and render its determination within 90 days after the end of the first year, or, if683
applicable, the first time period described in paragraph (1) of this subsection during684
which the new perinatal service fails to provide indigent or charity care in accordance685
with the requirements of paragraph (1) of this subsection.  Revocation shall be effective686
30 days after the date of the determination by the department that the requirements of687
paragraph (1) of this subsection have not been met.688
(c)(1)  A new perinatal service shall achieve the standard number of births specified in689
the state health plan in effect at the time of the issuance of the certificate of need approval690
by the department in at least one year during its first three years of operation.691
(2)  The department shall revoke the certificate of need and authority to operate of a new692
perinatal service if after notice to the grantee of the certificate of need or such grantee's693
successors, and after opportunity for a fair hearing pursuant to Chapter 13 of Title 50, the694
'Georgia Administrative Procedure Act,' the department determines that such new695
perinatal service has failed to comply with the applicable requirements of paragraph (1)696
of this subsection and such failure is determined by the department to be for reasons697 23 LC 33 9350
S. B. 162
- 28 -
substantially within the perinatal service provider's control.  The department shall provide698
the requisite notice, conduct the fair hearing, if requested, and render its determination699
within 90 days after the end of the new perinatal service's first three years of operation.700
Revocation shall be effective 30 days after the date of the determination by the701
department that the requirements of this paragraph or paragraph (1) of this subsection702
have not been met.703
(d)  Nothing contained in this Code section shall limit the department's authority to regulate704
perinatal services in ways or for time periods not addressed by the provisions of this Code705
section.706
31-6-40.3.707
(a)  On and after July 1, 2019, a destination cancer hospital may apply for a certificate of708
need to convert to a general cancer hospital in accordance with this Code section.  A709
destination cancer hospital that elects to convert to a general cancer hospital shall notify710
the department in a form and manner established by the department.711
(b)  The department shall establish a form and process for a destination cancer hospital to712
submit a certificate of need application to convert to a general cancer hospital; provided,713
however, that such a conversion shall not be subject to any of the considerations in Code714
Section 31-6-42 or service specific rules and shall not be subject to opposition or appeal715
by any other health care facilities.  The department shall develop such form and guidance716
required by this subsection within 30 days of July 1, 2019.  Upon its receipt of a complete717
application for a destination cancer hospital to convert to a general cancer hospital, the718
department shall issue such certificate of need within 60 days.719
(c)  Upon the conversion of a destination cancer hospital to a general cancer hospital:720
(1)  The general cancer hospital may continue to provide all institutional health care721
services and other services it provided as of the date of such conversion, including but not722
limited to inpatient beds, outpatient services, surgery, radiation therapy, imaging, and723 23 LC 33 9350
S. B. 162
- 29 -
positron emission tomography (PET) scanning, without any further approval from the724
department;725
(2)  The destination cancer hospital shall be classified as a general cancer hospital under726
this chapter and shall be subject to all requirements and conditions applicable to hospitals727
under this article, including but not limited to, indigent and charity care and inventories728
and methodologies to determine need for additional providers or services; and729
(3)  The hospital's inpatient beds, operating rooms, radiation therapy equipment, and730
imaging equipment existing on the date of conversion shall not be counted in the731
inventory by the department for purposes of determining need for additional providers732
or services, except that any inpatient beds, operating rooms, radiation therapy equipment,733
and imaging equipment added after the date of conversion shall be counted in accordance734
with the department's rules and regulations.735
(d)  In the event that a destination cancer hospital does not convert to a general cancer736
hospital, it shall remain subject to all requirements and conditions applicable to destination737
cancer hospitals under this article.738
31-6-41.739
(a)  A certificate of need shall be valid only for the defined scope, location, cost, service740
area, and person named in an application, as it may be amended, and as such scope,741
location, service area, cost, and person are approved by the department, unless such742
certificate of need owned by an existing health care facility is transferred to a person who743
acquires such existing facility.  In such case, the certificate of need shall be valid for the744
person who acquires such a facility and for the scope, location, cost, and service area745
approved by the department.  However, in reviewing an application to relocate all or a746
portion of an existing skilled nursing facility, intermediate care facility, or intermingled747
nursing facility, the department may allow such facility to divide into two or more such748 23 LC 33 9350
S. B. 162
- 30 -
facilities if the department determines that the proposed division is financially feasible and
749
would be consistent with quality patient care.750
(b)  A certificate of need shall be valid and effective for a period of 12 months after it is751
issued, or such greater period of time as may be specified by the department at the time the752
certificate of need is issued.  Within the effective period after the grant of a certificate of753
need, the applicant of a proposed project shall fulfill reasonable performance and754
scheduling requirements specified by the department, by rule, to assure reasonable progress755
toward timely completion of a project.756
(c)  By rule, the department may provide for extension of the effective period of a757
certificate of need when an applicant, by petition, makes a good faith showing that the758
conditions to be specified according to subsection (b) of this Code section will be759
performed within the extended period and that the reasons for the extension are beyond the760
control of the applicant.761
31-6-42.762
(a)  The written findings of fact and decision, with respect to the department's grant or763
denial of a certificate of need, shall be based on the applicable considerations specified in764
this Code section and reasonable rules promulgated by the department interpretive thereof.765
The department shall issue a certificate of need to each applicant whose application is766
consistent with the following considerations and such rules deemed applicable to a project,767
except as specified in subsection (f) of Code Section 31-6-43:768
(1)  The proposed new institutional health services are reasonably consistent with the769
relevant general goals and objectives of the state health plan;770
(2)  The population residing in the area served, or to be served, by the new institutional771
health service has a need for such services;772
(3)  Existing alternatives for providing services in the service area the same as the new773
institutional health service proposed are neither currently available, implemented,774 23 LC 33 9350
S. B. 162
- 31 -
similarly utilized, nor capable of providing a less costly alternative, or no certificate of
775
need to provide such alternative services has been issued by the department and is776
currently valid;777
(4)  The project can be adequately financed and is, in the immediate and long term,778
financially feasible;779
(5)  The effects of new institutional health service on payors
 payers for health services,780
including governmental payors payers, are not unreasonable;781
(6)  The costs and methods of a proposed construction project, including the costs and782
methods of energy provision and conservation, are reasonable and adequate for quality783
health care;784
(7)  The new institutional health service proposed is reasonably financially and physically785
accessible to the residents of the proposed service area;786
(8)  The proposed new institutional health service has a positive relationship to the787
existing health care delivery system in the service area;788
(9)  The proposed new institutional health service encourages more efficient utilization789
of the health care facility proposing such service;790
(10)  The proposed new institutional health service provides, or would provide, a791
substantial portion of its services to individuals not residing in its defined service area or792
the adjacent service area;793
(11)  The proposed new institutional health service conducts biomedical or behavioral794
research projects or new service development which is designed to meet a national,795
regional, or state-wide need;796
(12)  The proposed new institutional health service meets the clinical needs of health797
professional training programs which request assistance;798
(13)  The proposed new institutional health service fosters improvements or innovations799
in the financing or delivery of health services, promotes health care quality assurance or800 23 LC 33 9350
S. B. 162
- 32 -
cost effectiveness, or fosters competition that is shown to result in lower patient costs
801
without a loss of the quality of care;802
(14)  The proposed new institutional health service fosters the special needs and
803
circumstances of health maintenance organizations; Reserved;804
(15)  The proposed new institutional health service meets the department's minimum805
quality standards, including, but not limited to, standards relating to accreditation,806
minimum volumes, quality improvements, assurance practices, and utilization review807
procedures;808
(16)  The proposed new institutional health service can obtain the necessary resources,809
including health care personnel and management personnel; and810
(17)  The proposed new institutional health service is an underrepresented health service,811
as determined annually by the department.  The department shall, by rule, provide for an812
advantage to equally qualified applicants that agree to provide an underrepresented813
service in addition to the services for which the application was originally submitted.814
(b)  In the case of applications for the development or offering of a new institutional health815
service or health care facility for osteopathic medicine, the need for such service or facility816
shall be determined on the basis of the need and availability in the community for817
osteopathic services and facilities in addition to the considerations in subsection (a) of this818
Code section.  Nothing in this chapter shall, however, be construed as otherwise819
recognizing any distinction between allopathic and osteopathic medicine.820
(b.1)  In the case of applications for the construction, development, or establishment of a821
destination cancer hospital, the applicable considerations as to the need for such service822
shall not include paragraphs (1), (2), (3), (7), (8), (10), (11), and (14) of subsection (a) of823
this Code section but shall include:824
(1)  Paragraphs (4), (5), (6), (9), (12), (13), (15), (16), and (17) of subsection (a) of this825
Code section;826 23 LC 33 9350
S. B. 162
- 33 -
(2)  That the proposed new destination cancer hospital can demonstrate, based on827
historical data from the applicant or its affiliated entities, that its annual patient base shall828
be composed of a minimum of 65 percent of patients who reside outside of the State of829
Georgia;830
(3)  That the proposed new destination cancer hospital states its intent to provide831
uncompensated indigent or charity care which shall meet or exceed 3 percent of its832
adjusted gross revenues and provide care to Medicaid beneficiaries;833
(4)  That the proposed new destination cancer hospital shall conduct biomedical or834
behavioral research projects or service development which is designed to meet a national835
or regional need;836
(5)  That the proposed new destination cancer hospital shall be reasonably financially and837
physically accessible;838
(6)  That the proposed new destination cancer hospital shall have a positive relationship839
to the existing health care delivery system on a regional basis;840
(6.1)  That the proposed new destination cancer hospital shall enter into a hospital841
transfer agreement with one or more hospitals within a reasonable distance from the842
destination cancer hospital or the medical staff at the destination cancer hospital has843
admitting privileges or other acceptable documented arrangements with such hospital or844
hospitals to ensure the necessary backup for the destination cancer hospital for medical845
complications.  The destination cancer hospital shall have the capability to transfer a846
patient immediately to a hospital within a reasonable distance from the destination cancer847
hospital with adequate emergency room services.  Hospitals shall not unreasonably deny848
a transfer agreement with the destination cancer hospital.  In the event that a destination849
cancer hospital and another hospital cannot agree to the terms of a transfer agreement as850
required by this paragraph, the department shall mediate between such parties for a period851
of no more than 45 days.  If an agreement is still not reached within such 45 day period,852
the parties shall enter into binding arbitration conducted by the department;853 23 LC 33 9350
S. B. 162
- 34 -
(7)  That an applicant for a new destination cancer hospital shall document in its854
application that the new facility is not predicted to be detrimental to existing hospitals855
within the planning area.  Such demonstration shall be made by providing an analysis in856
such application that compares current and projected changes in market share and payor857
mix for such applicant and such existing hospitals within the planning area.  Impact on858
an existing hospital shall be determined to be adverse if, based on the utilization projected859
by the applicant, such existing hospital would have a total decrease of 10 percent or more860
in its average annual utilization, as measured by patient days for the two most recent and861
available preceding calendar years of data; and862
(8)  That the destination cancer hospital shall express its intent to participate in medical863
staffing work force development activities.864
(b.2)  In the case of applications for basic perinatal services in counties where:865
(1)  Only one civilian health care facility or health system is currently providing basic866
perinatal services; and867
(2)  There are not at least three different health care facilities in a contiguous county868
providing basic perinatal services,869
the department shall not apply the consideration contained in paragraph (2) of870
subsection (a) of this Code section.871
(c)  If the denial of an application for a certificate of need for a new institutional health872
service proposed to be offered or developed by a:873
(1)  Minority administered hospital facility serving a socially and economically874
disadvantaged minority population in an urban setting; or875
(2)  Minority administered hospital facility utilized for the training of minority medical876
practitioners877
would adversely impact upon the facility and population served by said facility, the special878
needs of such hospital facility and the population served by said facility for the new879
institutional health service shall be given extraordinary consideration by the department in880 23 LC 33 9350
S. B. 162
- 35 -
making its determination of need as required by this Code section.  The department shall881
have the authority to vary or modify strict adherence to the provisions of this chapter and882
the rules enacted pursuant hereto in considering the special needs of such facility and its883
population served and to avoid an adverse impact on the facility and the population served884
thereby.  For purposes of this subsection, the term 'minority administered hospital facility'885
means a hospital controlled or operated by a governing body or administrative staff886
composed predominantly of members of a minority race.887
(d)(b) For the purposes of the considerations contained in this Code section and in the888
department's applicable rules, relevant data which were unavailable or omitted when the889
state health plan or rules were prepared or revised may be considered in the evaluation of890
a project.891
(e)(c) The department shall specify in its written findings of fact and decision which of the892
considerations contained in this Code section and the department's applicable rules are893
applicable to an application and its reasoning as to and evidentiary support for its894
evaluation of each such applicable consideration and rule.895
31-6-42.1.896
No applicant for a new certificate of need, a modification to an existing certificate of need,897
or a conversion of a certificate of need that has any outstanding amounts owed to the state898
including fines, penalties, fees, or other payments for noncompliance with any899
requirements contained in Code Section 31-6-40.1, 31-6-45.2, 31-6-70, 31-7-280, or900
31-8-179.2 shall be eligible to receive a new certificate of need or a modification to an901
existing certificate of need unless such applicant pays such outstanding amounts to the902
state.  Any such fines, penalties, fees, or other payments for noncompliance shall be subject903
to the same notices and hearing for the levy of fines under Code Section 31-6-45.904 23 LC 33 9350
S. B. 162
- 36 -
31-6-43.
905
(a)  At least 30 days prior to submitting an application for a certificate of need for clinical906
health services, a person shall submit a letter of intent to the department.  The department907
shall provide by rule a process for submitting letters of intent and a mechanism by which908
applications may be filed to compete with and be reviewed comparatively with proposals909
described in submitted letters of intent.910
(b)  Each application for a certificate of need shall be reviewed by the department and911
within ten working days after the date of its receipt a determination shall be made as to912
whether the application complies with the rules governing the preparation and submission913
of applications.  If the application complies with the rules governing the preparation and914
submission of applications, the department shall declare the application complete for915
review, shall accept and date the application, and shall notify the applicant of the timetable916
for its review.  The department shall also notify a newspaper of general circulation in the917
county in which the project shall be developed that the application has been deemed918
complete.  The department shall also notify the appropriate regional commission and the919
chief elected official of the county and municipal governments, if any, in whose boundaries920
the proposed project will be located that the application is complete for review.  If the921
application does not comply with the rules governing the preparation and submission of922
applications, the department shall notify the applicant in writing and provide a list of all923
deficiencies.  The applicant shall be afforded an opportunity to correct such deficiencies,924
and upon such correction, the application shall then be declared complete for review within925
ten days of the correction of such deficiencies, and notice given to a newspaper of general926
circulation in the county in which the project shall be developed that the application has927
been so declared.  The department shall also notify the appropriate regional commission928
and the chief elected official of the county and municipal governments, if any, in whose929
boundaries the proposed project will be located that the application is complete for review930
or when in the determination of the department a significant amendment is filed.931 23 LC 33 9350
S. B. 162
- 37 -
(c)  The department shall specify by rule the time within which an applicant may amend
932
its application.  The department may request an applicant to make amendments.  The933
department decision shall be made on an application as amended, if at all, by the applicant.934
(d)(1)  There shall be a time limit of 120 days for review of a project, beginning on the935
day the department declares the application complete for review or in the case of936
applications joined for comparative review, beginning on the day the department declares937
the final application complete.  The department may adopt rules for determining when938
it is not practicable to complete a review in 120 days and may extend the review period939
upon written notice to the applicant but only for an extended period of not longer than an940
additional 30 days.  The department shall adopt rules governing the submission of941
additional information by the applicant and for opposing an application.942
(2)  No party may oppose an application for a certificate of need for a proposed project943
unless:944
(A)  Such party offers substantially similar services as proposed within a 35 mile radius945
of the proposed project or has a service area that overlaps the applicant's proposed946
service area; or947
(B)  Such party has submitted a competing application in the same batching cycle and948
is proposing to establish the same type of facility proposed or offers substantially949
similar services as proposed and has a service area that overlaps the applicant's950
proposed service area.951
(e)  To allow the opportunity for comparative review of applications, the department may952
provide by rule for applications for a certificate of need to be submitted on a timetable or953
batching cycle basis no less often than two times per calendar year for each clinical health954
service.  Applications for services, facilities, or expenditures for which there is no specified955
batching cycle may be filed at any time.956 23 LC 33 9350
S. B. 162
- 38 -
(f)  The department may order the joinder of an application which is determined to be
957
complete by the department for comparative review with one or more subsequently filed958
applications declared complete for review during the same batching cycle when:959
(1)  The first and subsequent applications involve similar clinical health service projects960
in the same service area or overlapping service areas; and961
(2)  The subsequent applications are filed and are declared complete for review within 30962
days of the date the first application was declared complete for review.963
Following joinder of the first application with subsequent applications, none of the964
subsequent applications so joined may be considered as a first application for the purposes965
of future joinder.  The department shall notify the applicant to whose application a joinder966
is ordered and all other applicants previously joined to such application of the fact of each967
joinder pursuant to this subsection.  In the event one or more applications have been joined968
pursuant to this subsection, the time limits for department action for all of the applicants969
shall run from the latest date that any one of the joined applications was declared complete970
for review.  In the event of the consideration of one or more applications joined pursuant971
to this subsection, the department may award no certificate of need or one or more972
certificates of need to the application or applications
 applicant or applicants, if any, which973
are consistent with the considerations contained in Code Section 31-6-42, the department's974
applicable rules, and the award of which will best satisfy the purposes of this chapter.975
(g)  The department shall review the application and all written information submitted by976
the applicant in support of the application and all information submitted in opposition to977
the application to determine the extent to which the proposed project is consistent with the978
applicable considerations stated in Code Section 31-6-42 and in the department's applicable979
rules.  During the course of the review, the department staff may request additional980
information from the applicant as deemed appropriate.  Pursuant to rules adopted by the981
department, a public hearing on applications covered by those regulations may be held982
prior to the date of the department's decision thereon.  Such rules shall provide that when983 23 LC 33 9350
S. B. 162
- 39 -
good cause has been shown, a public hearing shall be held by the department.  Any
984
interested person may submit information to the department concerning an application, and985
an applicant shall be entitled to notice of and to respond to any such submission.986
(h)  The department shall provide the applicant an opportunity to meet with the department987
to discuss the application and to provide an opportunity to submit additional information.988
Such additional information shall be submitted within the time limits adopted by the989
department.  The department shall also provide an opportunity for any party that is990
permitted to oppose an application pursuant to paragraph (2) of subsection (d) of this Code991
section to meet with the department and to provide additional information to the992
department.  In order for any such opposing party to have standing to appeal an adverse993
decision pursuant to Code Section 31-6-44, such party must attend and participate in an994
opposition meeting.995
(i)  Unless extended by the department for an additional period of up to 30 days pursuant996
to subsection (d) of this Code section, the department shall, no later than 120 days after an997
application is determined to be complete for review, or, in the event of joined applications,998
120 days after the last application is declared complete for review, provide written999
notification to an applicant of the department's decision to issue or to deny issuance of a1000
certificate of need for the proposed project.  Such notice shall contain the department's1001
written findings of fact and decision as to each applicable consideration or rule and a1002
detailed statement of the reasons and evidentiary support for issuing or denying a certificate1003
of need for the action proposed by each applicant.  The department shall also mail such1004
notification to the appropriate regional commission and the chief elected official of the1005
county and municipal governments, if any, in whose boundaries the proposed project will1006
be located.  In the event such decision is to issue a certificate of need, the certificate of1007
need shall be effective on the day of the decision unless the decision is appealed to the1008
Certificate of Need Appeal Panel in accordance with this chapter.  Within seven days of1009 23 LC 33 9350
S. B. 162
- 40 -
the decision, the department shall publish notice of its decision to grant or deny an
1010
application in the same manner as it publishes notice of the filing of an application.1011
(j)  Should the department fail to provide written notification of the decision within the1012
time limitations set forth in this Code section, an application shall be deemed to have been1013
approved as of the one hundred twenty-first day following notice from the department that1014
an application, or the last of any applications joined pursuant to subsection (f) of this Code1015
section, is declared 'complete for review.'1016
(k)  Notwithstanding other provisions of this article, when the Governor has declared a1017
state of emergency in a region of the state, existing health care facilities in the affected1018
region may seek emergency approval from the department to make expenditures in excess1019
of the capital expenditure threshold or to offer services that may otherwise require a1020
certificate of need.  The department shall give special expedited consideration to such1021
requests and may authorize such requests for good cause.  Once the state of emergency has1022
been lifted, any services offered by an affected health care facility under this subsection1023
shall cease to be offered until such time as the health care facility that received the1024
emergency authorization has requested and received a certificate of need.  For purposes of1025
this subsection, the term
 'good cause' means that authorization of the request shall directly1026
resolve a situation posing an immediate threat to the health and safety of the public.  The1027
department shall establish, by rule, procedures whereby requirements for the process of1028
review and issuance of a certificate of need may be modified and expedited as a result of1029
emergency situations.1030
31-6-44.1031
(a)  Effective July 1, 2008, there is created the Certificate of Need Appeal Panel, which1032
shall be an agency separate and apart from the department and shall consist of a panel of1033
independent hearing officers.  The purpose of the appeal panel shall be to serve as a panel1034
of independent hearing officers to review the department's initial decision to grant or deny1035 23 LC 33 9350
S. B. 162
- 41 -
a certificate of need application.  The Health Planning Review Board which existed on
1036
June 30, 2008, shall cease to exist after that date and the Certificate of Need Appeal Panel1037
shall be constituted effective July 1, 2008, pursuant to this Code section.1038
(b)  On and after July 1, 2008, the appeal panel shall be composed of five members1039
appointed by the Governor for a term of up to four years each.  The Governor shall appoint1040
to the  appeal panel attorneys who practice law in this state and who are familiar with the1041
health care industry but who do not have a financial interest in or represent or have any1042
compensation arrangement with any health care facility.  Each member of the appeal panel1043
shall be an active member of the State Bar of Georgia in good standing, and each attorney1044
shall have maintained such active status for the five years immediately preceding such1045
person's appointment.  The Governor shall name from among such members a chairperson1046
and a vice chairperson of the appeal panel.  The vice chairperson shall have the same1047
authority as the chairperson; provided, however, that
 the vice chairperson shall not exercise1048
such authority unless expressly delegated by the chairperson or in the event the chairperson1049
becomes incapacitated, as determined by the Governor.  Vacancies on the appeal panel1050
caused by resignation, death, or any other cause shall be filled for the unexpired term in the1051
same manner as the original appointment.  No person required to register with the Secretary1052
of State as a lobbyist or registered agent shall be eligible for appointment by the Governor1053
to the appeal panel.1054
(c)  The appeal panel shall promulgate reasonable rules for its operation and rules of1055
procedure for the conduct of initial administrative appeal hearings held by the appointed1056
hearing officers, including an appropriate fee schedule for filing such appeals.  Members1057
of the appeal panel shall serve as hearing officers for appeals that are assigned to them on1058
a random basis by the chairperson of the appeal panel.  The members of the appeal panel1059
shall receive no salary but shall be reimbursed for their expenses in attending meetings and1060
for transportation costs as authorized by Code Section 45-7-21, which provides for1061
compensation and allowances of certain state officials; provided, however, that the1062 23 LC 33 9350
S. B. 162
- 42 -
chairperson and vice chairperson of the appeal panel shall also be compensated for their
1063
services rendered to the appeal panel outside of attendance at an appeal panel meeting, such1064
as for time spent assigning hearing officers, the amount of which compensation shall be1065
determined according to regulations of the Department of Administrative Services.  Appeal1066
panel members shall receive compensation for the administration of the cases assigned to1067
them, including prehearing, hearing, and posthearing work, in an amount determined to be1068
appropriate and reasonable by the Department of Administrative Services.  Such1069
compensation to the members of the appeal panel shall be made by the Department of1070
Administrative Services.1071
(d)  Any party that is permitted to oppose an application pursuant to paragraph (2) of1072
subsection (d) of Code Section 31-6-43 that has notified the department prior to its decision1073
that such party is opposed to the application before the department shall have the right to1074
an initial administrative appeal hearing before an appeal panel hearing officer or to1075
intervene in such hearing.  Such request for hearing or intervention shall be filed with the1076
chairperson of the appeal panel within 30 days of the date of the decision made pursuant1077
to Code Section 31-6-43.  In the event an appeal is filed by a party that is permitted to1078
oppose an application pursuant to paragraph (2) of subsection (d) of Code Section 31-6-43,1079
the appeal shall be accompanied by payment of such fee as is established by the appeal1080
panel.  In the event an appeal is requested, the chairperson of the appeal panel shall appoint1081
a hearing officer for each such hearing within 30 days after the date the appeal is received.1082
Within 14 days after the appointment of the hearing officer, such hearing officer shall1083
confer with the parties and set the date or dates for the hearing, provided that no hearing1084
shall be scheduled less than 60 days nor more than 120 days after the filing of the request1085
for a hearing, unless the applicant consents or, in the case of competing applicants, all1086
applicants consent to an extension of this time period to a specified date.  Unless the1087
applicant consents or, in the case of competing applicants, all applicants consent to an1088
extension of said 120 day period, any hearing officer who regularly fails to commence a1089 23 LC 33 9350
S. B. 162
- 43 -
hearing within the required time period shall not be eligible for continued service as a
1090
hearing officer for the purposes of this Code section.  The hearing officer shall have the1091
authority to dispose of all motions made by any party before the issuance of the hearing1092
officer's decision and shall make such rulings as may be required for the conduct of the1093
hearing.1094
(e)  In fulfilling the functions and duties of this chapter, the hearing officer shall act, and1095
the hearing shall be conducted as a full evidentiary hearing, in accordance with Chapter 131096
of Title 50, the 'Georgia Administrative Procedure Act,' relating to contested cases, except1097
as otherwise specified in this Code section.  Subject to the provisions of Article 4 of1098
Chapter 18 of Title 50, all files, working papers, studies, notes, and other writings or1099
information used by the department in making its decision shall be public records and1100
available to the parties, and the hearing officer may permit each party to exercise such1101
reasonable rights of prehearing discovery of such information used by the parties as will1102
expedite the hearing.1103
(f)  In addition to evidence submitted to the department, a party may present any additional1104
relevant evidence to the appeal panel hearing officer reviewing the decision of the1105
department if the evidence was not reasonably available to the party presenting the1106
evidence at the time of the department's review.  The burden of proof as to whether the1107
evidence was reasonably available shall be on the party attempting to introduce the new1108
evidence.  The issue for the decision by the hearing officer shall be whether, and the1109
hearing officer shall order the issuance of a certificate of need if, in the hearing officer's1110
judgment, the application is consistent with the considerations as set forth in Code Section1111
31-6-42 and the department's rules, as the hearing officer deems such considerations and1112
rules applicable to the review of the project.  The appeal hearing conducted by the appeal1113
panel hearing officer shall be a de novo review of the decision of the department.  The1114
hearing officer shall also consider:1115 23 LC 33 9350
S. B. 162
- 44 -
(1)  Whether the department committed prejudicial procedural error in its consideration
1116
of the application;1117
(2)  Whether the appeal lacks substantial justification; and1118
(3)  Whether such appeal was undertaken primarily for the purpose of delay or1119
harassment.1120
The burden of proof shall be on the appellant.  Appellants or applicants shall proceed first1121
with their cases before the hearing officer in the order determined by the hearing officer,1122
and the department, if a party, shall proceed last.  In the event of a consolidated hearing on1123
applications which were joined for comparative review pursuant to subsection (f) of Code1124
Section 31-6-43, the hearing officer shall have the same powers specified for the1125
department in subsection (f) of Code Section 31-6-43 to order the issuance of no certificate1126
of need or one or more certificates of need.1127
(g)  All evidence shall be presented at the initial administrative appeal hearing conducted1128
by the appointed hearing officer.  A party or intervenor may present any relevant evidence1129
on all issues raised by the hearing officer or any party to the hearing or revealed during1130
discovery and shall not be limited to evidence or information presented to the department1131
prior to its decision, except that an applicant may not present a new need study or analysis1132
responsive to the general need consideration or service-specific need formula as provided1133
in the applicable rules that is substantially different from any such study or analysis1134
submitted to the department prior to its decision and that could have reasonably been1135
available for submission.  The hearing officer may consider the latest data available,1136
including updates of studies previously submitted, in deciding whether an application is1137
consistent with the applicable considerations or rules.  The hearing officer shall consider1138
the applicable considerations and rules in effect on the date the appeal is filed, even if the1139
provisions of those considerations or rules were changed after the department's decision.1140
The hearing officer may remand a matter to the department if the hearing officer1141
determines that it would be beneficial for the department to consider new data, studies, or1142 23 LC 33 9350
S. B. 162
- 45 -
analyses that were not available before the decision or changes to the provisions of the
1143
applicable considerations or rules made after the department's decision.  The hearing officer1144
shall establish the time deadlines for completion of the remand and shall retain jurisdiction1145
of the matter throughout the completion of the remand.1146
(h)  After the issuance of a decision by the department pursuant to Code Section 31-6-43,1147
no party to an appeal hearing, nor any person on behalf of such party, including the1148
department, shall make any ex parte contact with the appeal panel hearing officer appointed1149
to conduct the appeal hearing, any other member of the appeal panel, or the commissioner1150
in regard to a decision under appeal.1151
(i)  Within 30 days after the conclusion of the hearing, the hearing officer shall make1152
written findings of fact and conclusions of law as to each consideration as set forth in Code1153
Section 31-6-42 and the department's rules, including a detailed statement of the reasons1154
for the decision of the hearing officer.  If any party has alleged that an appeal lacks1155
substantial justification or was undertaken primarily for the purpose of delay or harassment,1156
the decision of the hearing officer shall make findings of fact addressing the merits of the1157
allegation.  The hearing officer shall file such decision with the chairperson of the appeal1158
panel who shall serve such decision upon all parties, and shall transmit the administrative1159
record to the commissioner.  Any party, including the department, which disputes any1160
finding of fact or conclusion of law rendered by the hearing officer in such hearing officer's1161
decision and which wishes to appeal that decision may appeal to the commissioner and1162
shall file its specific objections with the commissioner or his or her designee within 30 days1163
of the date of the hearing officer's decision pursuant to rules adopted by the department.1164
(j)  The decision of the appeal panel hearing officer will become the final decision of the1165
department upon the sixty-first day following the date of the decision unless an objection1166
thereto is filed with the commissioner within the time limit established in subsection (i) of1167
this Code section.1168 23 LC 33 9350
S. B. 162
- 46 -
(k)(1)  In the event an appeal of the hearing officer's decision is filed, the commissioner
1169
may adopt the hearing officer's order as the final order of the department or the1170
commissioner may reject or modify the conclusions of law over which the department has1171
substantive jurisdiction and the interpretation of administrative rules over which it has1172
substantive jurisdiction.  By rejecting or modifying such conclusion of law or1173
interpretation of administrative rule, the department must state with particularity its1174
reasons for rejecting or modifying such conclusion of law or interpretation of1175
administrative rule and must make a finding that its substituted conclusion of law or1176
interpretation of administrative rule is as or more reasonable than that which was rejected1177
or modified.  Rejection or modification of conclusions of law may not form the basis for1178
rejection or modification of findings of fact.  The commissioner may not reject or modify1179
the findings of fact unless the commissioner first determines from a review of the entire1180
record, and states with particularity in the order, that the findings of fact were not based1181
upon any competent substantial evidence or that the proceedings on which the findings1182
were based did not comply with the essential requirements of law.1183
(2)  If, before the date set for the commissioner's decision, application is made to the1184
commissioner for leave to present additional evidence and it is shown to the satisfaction1185
of the commissioner that the additional evidence is material and there were good reasons1186
for failure to present it in the proceedings before the hearing officer, the commissioner1187
may order that the additional evidence be taken before the same hearing officer who1188
rendered the initial decision upon conditions determined by the commissioner.  The1189
hearing officer may modify the initial decision by reason of the additional evidence and1190
shall file that evidence and any modifications, new findings, or decision with the1191
commissioner.  Unless leave is given by the commissioner in accordance with the1192
provisions of this subsection, the appeal panel may not consider new evidence under any1193
circumstances.  In all circumstances, the commissioner's decision shall be based upon1194
considerations as set forth in Code Section 31-6-42 and the department's rules.1195 23 LC 33 9350
S. B. 162
- 47 -
(l)  If, based upon the findings of fact by the hearing officer, the commissioner determines
1196
that the appeal filed by any party of a decision of the department lacks substantial1197
justification and was undertaken primarily for the purpose of delay or harassment, the1198
commissioner may enter an award in his or her written order against such party and in1199
favor of the successful party or parties, including the department, of all or any part of their1200
respective reasonable and necessary attorney's fees and expenses of litigation, as the1201
commissioner deems just.  Such award may be enforced by any court undertaking judicial1202
review of the final decision.  In the absence of any petition for judicial review, then such1203
award shall be enforced, upon due application, by any court having personal jurisdiction1204
over the party against whom such an award is made.1205
(m)  Unless the hearing officer's decision becomes the department's final decision by1206
operation of law as provided in subsection (j) of this Code section, the decision of the1207
commissioner shall become the department's final decision by operation of law.  Such final1208
decision shall be the final department decision for purposes of Chapter 13 of Title 50, the1209
'Georgia Administrative Procedure Act.'  The appeals process provided by this Code1210
section shall be the administrative remedy only for decisions made by the department1211
pursuant to Code Section 31-6-43 which involve the approval or denial of applications for1212
certificates of need.1213
(n)  A party responding to an appeal to the commissioner may be entitled to reasonable1214
attorney's fees and costs of such appeal if it is determined that the appeal lacked substantial1215
justification and was undertaken primarily for the purpose of delay or harassment;1216
provided, however, that the department shall not be required to pay attorney's fees or costs.1217
This subsection shall not apply to the portion of attorney's fees accrued on behalf of a party1218
responding to or bringing a challenge to the department's authority to enact a rule or1219
regulation or the department's jurisdiction or another challenge that could not have been1220
decided in the administrative proceeding, nor shall it apply to costs accrued when the only1221
argument raised by the appealing party is one described in this subsection.1222 23 LC 33 9350
S. B. 162
- 48 -
31-6-44.1.
1223
(a)  Any party to the initial administrative appeal hearing conducted by the appointed1224
appeal panel hearing officer, excluding the department, may seek judicial review of the1225
final decision in accordance with the method set forth in Chapter 13 of Title 50, the1226
'Georgia Administrative Procedure Act,' except as otherwise modified by this Code section;1227
provided, however, that in conducting such review, the court may reverse or modify the1228
final decision only if substantial rights of the appellant have been prejudiced because the1229
procedures followed by the department, the hearing officer, or the commissioner or the1230
administrative findings, inferences, and conclusions contained in the final decision are:1231
(1)  In violation of constitutional or statutory provisions;1232
(2)  In excess of the statutory authority of the department;1233
(3)  Made upon unlawful procedures;1234
(4)  Affected by other error of law;1235
(5)  Not supported by substantial evidence, which shall mean that the record does not1236
contain such relevant evidence as a reasonable mind might accept as adequate to support1237
such findings, inferences, conclusions, or decisions, which such evidentiary standard shall1238
be in excess of the 'any evidence' standard contained in other statutory provisions; or1239
(6)  Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted1240
exercise of discretion.1241
(b)  In the event a party seeks judicial review, the proceedings for such review shall be1242
governed by Chapter 3 of Title 5 except as provided otherwise in this Code section.  If a1243
party seeks judicial review, the department shall, within 30 days after being served with a1244
copy of the petition for review filed in the superior court, transmit certified copies of all1245
documents and papers in its file together with a transcript of the testimony taken and its1246
findings of fact and decision to the clerk of the superior court to which the case has been1247
appealed.  The case so appealed may then be brought by either party upon ten days' written1248
notice to the other before the superior court for a hearing upon such record, subject to an1249 23 LC 33 9350
S. B. 162
- 49 -
assignment of the case for hearing by the court; provided, however, that, if the court does
1250
not hear the case within 120 days of the date of docketing in the superior court, the decision1251
of the department shall be considered affirmed by operation of law unless a hearing1252
originally scheduled to be heard within the 120 days has been continued to a date certain1253
by order of the court.  In the event a hearing is held later than 90 days after the date of1254
docketing in the superior court because same has been continued to a date certain by order1255
of the court, the decision of the department shall be considered affirmed by operation of1256
law if no order of the court disposing of the issues on appeal has been entered within 301257
days after the date of the continued hearing.  If a case is heard within 120 days from the1258
date of docketing in the superior court, the decision of the department shall be considered1259
affirmed by operation of law if no order of the court disposing of the issues on appeal has1260
been entered within 30 days of the date of the hearing.1261
(c)  A party responding to an appeal to the superior court shall be entitled to reasonable1262
attorney's fees and costs if such party is the prevailing party of such appeal as decided by1263
final order; provided, however, that
 the department shall not be required to pay attorney's1264
fees or costs.  This subsection shall not apply to the portion of attorney's fees accrued on1265
behalf of a party responding to or bringing a challenge to the department's authority to1266
enact a rule or regulation or the department's jurisdiction or another challenge that could1267
not have been raised in the administrative proceeding.1268
31-6-45.1269
(a)  The department may revoke a certificate of need, in whole or in part, after notice to the1270
holder of the certificate and a fair hearing pursuant to Chapter 13 of Title 50, the 'Georgia1271
Administrative Procedure Act,' for the following reasons:1272
(1)  Failure to comply with the provisions of Code Section 31-6-41;1273
(2)  The intentional provision of false information to the department by an applicant in1274
that applicant's application;1275 23 LC 33 9350
S. B. 162
- 50 -
(3)  Repeated failure to pay any fines or moneys due to the department;
1276
(4)  Failure to maintain minimum quality of care standards that may be established by the1277
department;1278
(5)  Failure to participate as a provider of medical assistance for Medicaid purposes1279
pursuant to Code Section 31-6-45.2 or any other applicable Code section; or
1280
(6)  The failure to submit a timely or complete report within 180 days following the date1281
the report is due pursuant to Code Section 31-6-70; or1282
(7)  Failure of a destination cancer hospital to meet an annual patient base composed of1283
a minimum of 65 percent of patients who reside outside this state for three calendar years1284
in any five-year period.1285
The department may not, however, revoke a certificate of need if the applicant changes the1286
defined location of the project within the same county less than three miles from the1287
location specified in the certificate of need for financial reasons or other reasons beyond1288
its control, including, but not limited to, failure to obtain any required approval from1289
zoning or other governmental agencies or entities, provided that such change in location1290
is otherwise consistent with the considerations and rules applied in the evaluation of the1291
project.1292
(a.1)  The department may revoke a certificate of need, in whole or in part, after notice to1293
the holder of the certificate and a fair hearing pursuant to Chapter 13 of Title 50, the1294
'Georgia Administrative Procedure Act,' if the services or units of services for which the1295
certificate of need was issued are not implemented in a timely manner, as established by1296
the department in its rules.  This subsection shall apply only to certificates of need issued1297
on or after July 1, 2008.1298
(b)  Any health care facility offering a new institutional health service without having1299
obtained a certificate of need and which has not been previously licensed as a health care1300
facility shall be denied a license to operate.1301 23 LC 33 9350
S. B. 162
- 51 -
(c)  In the event that a new institutional health service is knowingly offered or developed
1302
without having obtained a certificate of need as required by this chapter, or the certificate1303
of need for such service is revoked according to the provisions of this Code section, a1304
facility or applicant may be fined an amount of $5,000.00 per day up to 30 days,1305
$10,000.00 per day from 31 days through 60 days, and $25,000.00 per day after 60 days1306
for each day that the violation of this chapter has existed and knowingly and willingly1307
continues; provided, however, that the expenditure or commitment of or incurring an1308
obligation for the expenditure of funds to take or perform actions not subject to this chapter1309
or to acquire, develop, or prepare a health care facility site for which a certificate of need1310
application is denied shall not be a violation of this chapter and shall not be subject to such1311
a fine.  The commissioner shall determine, after notice and a hearing, whether the fines1312
provided in this Code section shall be levied.1313
(d)  In addition, for purposes of this Code section, the State of Georgia, acting by and1314
through the department, or any other interested person, shall have standing in any court of1315
competent jurisdiction to maintain an action for injunctive relief to enforce the provisions1316
of this chapter.1317
(e)  The department shall have the authority to make public or private investigations or1318
examinations inside or outside of this state to determine whether all provisions of this Code1319
section or any other law, rule, regulation, or formal order relating to the provisions of Code1320
Section 31-6-40 has been violated.  Such investigations may be initiated at any time in the1321
discretion of the department and may continue during the pendency of any action initiated1322
by the department pursuant to subsection (a) of this Code section.  For the purpose of1323
conducting any investigation or inspection pursuant to this subsection, the department shall1324
have the authority, upon providing reasonable notice, to require the production of any1325
books, records, papers, or other information related to any certificate of need issue.1326 23 LC 33 9350
S. B. 162
- 52 -
31-6-45.1.
1327
(a)  A health care facility which has a certificate of need or is otherwise authorized to1328
operate pursuant to this chapter shall have such certificate of need or authority to operate1329
automatically revoked by operation of law without any action by the department when that1330
facility's permit to operate pursuant to Code Section 31-7-4 is finally revoked by order of1331
the department.  For purposes of this subsection, the date of such final revocation shall be1332
as follows:1333
(1)  When there is no appeal of the order pursuant to Chapter 5 of this title, the one1334
hundred and eightieth day after the date upon which expires the time for appealing the1335
revocation order without such an appeal being filed; or1336
(2)  When there is an appeal of the order pursuant to Chapter 5 of this title, the date upon1337
which expires the time to appeal the last administrative or judicial order affirming or1338
approving the revocation or revocation order without such appeal being filed.1339
(b)  The services which had been authorized to be offered by a health care facility for1340
which a certificate of need has been revoked pursuant to subsection (a) of this Code section1341
may continue to be offered in the service area in which that facility was located under such1342
conditions as specified by the department notwithstanding that some or all of such services1343
could not otherwise be offered as new institutional health services.1344
31-6-45.2.1345
(a)  The department may require that any applicant for a certificate of need agree to1346
participate as a provider of medical assistance for Medicaid purposes pursuant to Article 71347
of Chapter 4 of Title 49.1348
(b)  Any proposed or existing health care facility which obtains a certificate of need on or1349
after April 6, 1992, based in part upon assurances that it will participate as a provider of1350
medical assistance, as defined in paragraph (6) of Code Section 49-4-141, and which1351
terminates its participation as a provider of medical assistance or violates any conditions1352 23 LC 33 9350
S. B. 162
- 53 -
imposed by the department relating to such participation, shall be subject to a monetary
1353
penalty in the amount of the difference between the Medicaid covered services which the1354
facility agreed to provide in its certificate of need application and the amount actually1355
provided and may be subject to revocation of its certificate of need by the department1356
pursuant to Code Section 31-6-45; provided, however, that this Code section shall not1357
apply if:1358
(1)  The proposed or existing health care facility's certificate of need application was1359
approved by the Health Planning Agency prior to April 6, 1992, and the Health Planning1360
Agency's approval of such application was under appeal on or after April 6, 1992, and the1361
Health Planning Agency's approval of such application is ultimately affirmed;1362
(2)  Such facility's participation as a provider of medical assistance is terminated by the1363
state or federal government; or1364
(3)  Such facility establishes good cause for terminating its participation as a provider of1365
medical assistance.  For purposes of this Code section, the term
 'good cause' shall mean:1366
(A)  Changes in the adequacy of medical assistance payments, as 'medical assistance'1367
is defined in paragraph (5) of Code Section 49-4-141, provided that at least 10 percent1368
of the facility's utilization during the preceding 12 month period was attributable to1369
services to recipients of medical assistance, as defined in paragraph (7) of Code1370
Section 49-4-141.  Medical assistance payments to a facility shall be presumed1371
adequate unless the revenues received by the facility from all sources are less than the1372
total costs set forth in the cost report for the preceding full 12 month period filed by1373
such facility pursuant to the state plan as defined in paragraph (8) of Code1374
Section 49-4-141 which are allowed under the state plan for purposes of determining1375
such facility's reimbursement rate for medical assistance and the aggregate amount of1376
such facility's medical assistance payments (including any amounts received by the1377
facility from recipients of medical assistance) during the preceding full 12 month cost1378
reporting period is less than 85 percent of such facility's Medicaid costs for such period.1379 23 LC 33 9350
S. B. 162
- 54 -
Medicaid costs shall be determined by multiplying the allowable costs set forth in the
1380
cost report, less any audit adjustments, by the percentage of the facility's utilization1381
during the cost reporting period which was attributable to recipients of medical1382
assistance;1383
(B)  Changes in the overall ability of the facility to cover its costs if such changes are1384
of such a degree as to seriously threaten the continued viability of the facility; or1385
(C)  Changes in the state plan, statutes, or rules and regulations governing providers of1386
medical assistance which impose substantial new obligations upon the facility which1387
are not reimbursed by Medicaid and which adversely affect the financial viability of the1388
facility in a substantial manner.1389
(c)  A facility seeking to terminate its enrollment as a provider of medical assistance shall1390
submit a written request to the department documenting good cause for termination.  The1391
department shall grant or deny the facility's request within 30 days.  If the department1392
denies the facility's request, the facility shall be entitled to a hearing conducted in the same1393
manner as an evidentiary hearing conducted by the department pursuant to the provisions1394
of Code Section 49-4-153 within 30 days of the department's decision.1395
(d)  The imposition of the monetary penalty provided in this Code section shall commence1396
upon the date that said facility has terminated its participation as a provider of medical1397
assistance, as determined by the commissioner.  The monetary penalty shall be levied and1398
collected by the department on an annual basis for every year in which the facility fails to1399
participate as a provider of medical assistance.  Penalties authorized under this Code1400
section shall be subject to the same notices and hearings as provided for levy of fines under1401
Code Section 31-6-45.1402
31-6-46.1403
The department shall prepare and submit an annual report to the board and to the Senate
1404
Health and Human Services Committee of the Senate and the House Committee on Health1405 23 LC 33 9350
S. B. 162
- 55 -
and Human Services Committee of the House of Representatives about its operations and1406
decisions for the preceding 12 month period, not later than 30 days prior to each convening1407
of the General Assembly in regular session.  Either committee may request any additional1408
reports or information, including decisions, from the department at any time, including a1409
period in which the General Assembly is not in regular session.  The annual report shall1410
include information and updates relating to the state health plan and the certificate of need1411
program and an annual analysis of proactive and prospective approaches to need1412
methodologies and access to health care services.  The annual report shall include1413
information for Georgia's congressional delegation which highlights issues regarding1414
federal laws and regulations influencing Medicaid and medicare, insurance and related tax1415
laws, and long-term health care.1416
31-6-47.1417
(a)  Notwithstanding the other provisions of this chapter, this chapter shall not apply to:1418
(1)  Infirmaries operated by educational institutions for the sole and exclusive benefit of1419
students, faculty members, officers, or employees thereof;1420
(2)  Infirmaries or facilities operated by businesses for the sole and exclusive benefit of1421
officers or employees thereof, provided that such infirmaries or facilities make no1422
provision for overnight stay by persons receiving their services;1423
(3)(1) Institutions operated exclusively by the federal government or by any of its1424
agencies;1425
(4)  Offices of private physicians or dentists whether for individual or group practice,1426
except as otherwise provided in paragraph (3) or (7) of subsection (a) of Code Section1427
31-6-40;1428
(5)(2) Religious, nonmedical health care institutions as defined in 42 U.S.C. Section1429
1395x(ss)(1), listed and certified by a national accrediting organization;1430 23 LC 33 9350
S. B. 162
- 56 -
(6)(3) Site acquisitions for health care facilities or preparation or development costs for1431
such sites prior to the decision to file a certificate of need application;1432
(7)(4) Expenditures related to adequate preparation and development of an application1433
for a certificate of need;1434
(8)(5) The commitment of funds conditioned upon the obtaining of a certificate of need;1435
(9)(6) Expenditures for the restructuring or acquisition of existing health care facilities1436
by stock or asset purchase, merger, consolidation, or other lawful means;1437
(9.1)  The purchase of a closing hospital or of a hospital that has been closed for no more1438
than 12 months by a hospital in a contiguous county to repurpose the facility as a1439
micro-hospital;1440
(10)  Expenditures of less than $870,000.00 for any minor or major repair or replacement1441
of equipment by a health care facility that is not owned by a group practice of physicians1442
or a hospital and that provides diagnostic imaging services if such facility received a1443
letter of nonreviewability from the department prior to July 1, 2008.  This paragraph shall1444
not apply to such facilities in rural counties;1445
(10.1)(7)  Expenditures Except as provided in paragraph (10) of this subsection,1446
expenditures for the minor or major repair of a health care facility or a facility that is1447
exempt from the requirements of this chapter, parts thereof or services provided or1448
equipment used therein; or the replacement of equipment, including but not limited to CT1449
scanners, magnetic resonance imaging, positron emission tomography (PET), and1450
positron emission tomography/computed tomography previously approved for a1451
certificate of need;1452
(11)(8) Capital expenditures otherwise covered by this chapter required solely to1453
eliminate or prevent safety hazards as defined by federal, state, or local fire, building,1454
environmental, occupational health, or life safety codes or regulations, to comply with1455
licensing requirements of the department, or to comply with accreditation standards of1456
a nationally recognized health care accreditation body;1457 23 LC 33 9350
S. B. 162
- 57 -
(12)(9) Cost overruns whose percentage of the cost of a project is equal to or less than1458
the cumulative annual rate of increase in the composite construction index, published by1459
the United States Bureau of the Census of the Department of Commerce, calculated from1460
the date of approval of the project;1461
(13)(10) Transfers from one health care facility to another such facility of major medical1462
equipment previously approved under or exempted from certificate of need review,1463
except where such transfer results in the institution of a new clinical health service for1464
which a certificate of need is required in the facility acquiring such equipment, provided1465
that such transfers are recorded at net book value of the medical equipment as recorded1466
on the books of the transferring facility;1467
(14)(11) New institutional health services provided by or on behalf of health1468
maintenance organizations or related health care facilities in circumstances defined by1469
the department pursuant to federal law;1470
(15)  Increases in the bed capacity of a hospital up to ten beds or 10 percent of capacity,1471
whichever is greater, in any consecutive two-year period, in a hospital that has1472
maintained an overall occupancy rate greater than 75 percent for the previous 12 month1473
period;1474
(16)(12) Expenditures for nonclinical projects, including parking lots, parking decks, and1475
other parking facilities; computer systems, software, and other information technology;1476
medical office buildings; administrative office space; conference rooms; education1477
facilities; lobbies; common spaces; clinical staff lounges and sleep areas; waiting rooms;1478
bathrooms; cafeterias; hallways; engineering facilities; mechanical systems; roofs;1479
grounds; signage; family meeting or lounge areas; and other nonclinical physical plant1480
renovations or upgrades that do not result in new or expanded clinical health services, and1481
state mental health facilities;1482
(17)(13) Life plan communities, provided that the skilled nursing component of the1483
facility is for the exclusive use of residents of the life plan community and that a written1484 23 LC 33 9350
S. B. 162
- 58 -
exemption is obtained from the department; provided, however, that new sheltered
1485
nursing home beds may be used on a limited basis by persons who are not residents of1486
the life plan community for a period up to five years after the date of issuance of the1487
initial nursing home license, but such beds shall not be eligible for Medicaid1488
reimbursement.  For the first year, the life plan community sheltered nursing facility may1489
utilize not more than 50 percent of its licensed beds for patients who are not residents of1490
the life plan community.  In the second year of operation, the life plan community shall1491
allow not more than 40 percent of its licensed beds for new patients who are not residents1492
of the life plan community.  In the third year of operation, the life plan community shall1493
allow not more than 30 percent of its licensed beds for new patients who are not residents1494
of the life plan community.  In the fourth year of operation, the life plan community shall1495
allow not more than 20 percent of its licensed beds for new patients who are not residents1496
of the life plan community.  In the fifth year of operation, the life plan community shall1497
allow not more than 10 percent of its licensed beds for new patients who are not residents1498
of the life plan community.  At no time during the first five years shall the life plan1499
community sheltered nursing facility occupy more than 50 percent of its licensed beds1500
with patients who are not residents under contract with the life plan community.  At the1501
end of the five-year period, the life plan community sheltered nursing facility shall be1502
utilized exclusively by residents of the life plan community, and at no time shall a1503
resident of a life plan community be denied access to the sheltered nursing facility.  At1504
no time shall any existing patient be forced to leave the life plan community to comply1505
with this paragraph.  The department is authorized to promulgate rules and regulations1506
regarding the use and definition of 'sheltered nursing facility' in a manner consistent with1507
this Code section.  Agreements to provide continuing care include agreements to provide1508
care for any duration, including agreements that are terminable by either party;1509
(18)  Any single specialty ambulatory surgical center that:
1510 23 LC 33 9350
S. B. 162
- 59 -
(A)(i)  Has capital expenditures associated with the construction, development, or1511
other establishment of the clinical health service which do not exceed $2.5 million;1512
or1513
(ii)  Is the only single specialty ambulatory surgical center in the county owned by the1514
group practice and has two or fewer operating rooms; provided, however, that a center1515
exempt pursuant to this division shall be required to obtain a certificate of need in1516
order to add any additional operating rooms;1517
(B)  Has a hospital affiliation agreement with a hospital within a reasonable distance1518
from the facility or the medical staff at the center has admitting privileges or other1519
acceptable documented arrangements with such hospital to ensure the necessary backup1520
for the center for medical complications.  The center shall have the capability to transfer1521
a patient immediately to a hospital within a reasonable distance from the facility with1522
adequate emergency room services.  Hospitals shall not unreasonably deny a transfer1523
agreement or affiliation agreement to the center;1524
(C)(i)  Provides care to Medicaid beneficiaries and, if the facility provides medical1525
care and treatment to children, to PeachCare for Kids beneficiaries and provides1526
uncompensated indigent and charity care in an amount equal to or greater than1527
2 percent of its adjusted gross revenue; or1528
(ii)  If the center is not a participant in Medicaid or the PeachCare for Kids Program,1529
provides uncompensated care to Medicaid beneficiaries and, if the facility provides1530
medical care and treatment to children, to PeachCare for Kids beneficiaries,1531
uncompensated indigent and charity care, or both in an amount equal to or greater1532
than 4 percent of its adjusted gross revenue;1533
provided, however, that single specialty ambulatory surgical centers owned by1534
physicians in the practice of ophthalmology shall not be required to comply with this1535
subparagraph; and1536 23 LC 33 9350
S. B. 162
- 60 -
(D)  Provides annual reports in the same manner and in accordance with Code1537
Section 31-6-70.1538
Noncompliance with any condition of this paragraph shall result in a monetary penalty1539
in the amount of the difference between the services which the center is required to1540
provide and the amount actually provided and may be subject to revocation of its1541
exemption status by the department for repeated failure to pay any fines or moneys due1542
to the department or for repeated failure to produce data as required by Code1543
Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to1544
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'  The dollar amount1545
specified in this paragraph shall be adjusted annually by an amount calculated by1546
multiplying such dollar amount (as adjusted for the preceding year) by the annual1547
percentage of change in the composite index of construction material prices, or its1548
successor or appropriate replacement index, if any, published by the United States1549
Department of Commerce for the preceding calendar year, commencing on July 1, 2009,1550
and on each anniversary thereafter of publication of the index.  The department shall1551
immediately institute rule-making procedures to adopt such adjusted dollar amounts.  In1552
calculating the dollar amounts of a proposed project for purposes of this paragraph, the1553
costs of all items subject to review by this chapter and items not subject to review by this1554
chapter associated with and simultaneously developed or proposed with the project shall1555
be counted, except for the expenditure or commitment of or incurring an obligation for1556
the expenditure of funds to develop certificate of need applications, studies, reports,1557
schematics, preliminary plans and specifications or working drawings, or to acquire sites;1558
(19)  Any joint venture ambulatory surgical center that:1559
(A)  Has capital expenditures associated with the construction, development, or other1560
establishment of the clinical health service which do not exceed $5 million;1561
(B)(i)  Provides care to Medicaid beneficiaries and, if the facility provides medical1562
care and treatment to children, to PeachCare for Kids beneficiaries and provides1563 23 LC 33 9350
S. B. 162
- 61 -
uncompensated indigent and charity care in an amount equal to or greater than 21564
percent of its adjusted gross revenue; or1565
(ii)  If the center is not a participant in Medicaid or the PeachCare for Kids Program,1566
provides uncompensated care to Medicaid beneficiaries and, if the facility provides1567
medical care and treatment to children, to PeachCare for Kids beneficiaries,1568
uncompensated indigent and charity care, or both in an amount equal to or greater1569
than 4 percent of its adjusted gross revenue; and1570
(C)  Provides annual reports in the same manner and in accordance with Code Section1571
31-6-70.1572
Noncompliance with any condition of this paragraph shall result in a monetary penalty1573
in the amount of the difference between the services which the center is required to1574
provide and the amount actually provided and may be subject to revocation of its1575
exemption status by the department for repeated failure to pay any fines or moneys due1576
to the department or for repeated failure to produce data as required by Code1577
Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to1578
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'  The dollar amount1579
specified in this paragraph shall be adjusted annually by an amount calculated by1580
multiplying such dollar amount (as adjusted for the preceding year) by the annual1581
percentage of change in the composite index of construction material prices, or its1582
successor or appropriate replacement index, if any, published by the United States1583
Department of Commerce for the preceding calendar year, commencing on July 1, 2009,1584
and on each anniversary thereafter of publication of the index.  The department shall1585
immediately institute rule-making procedures to adopt such adjusted dollar amounts.  In1586
calculating the dollar amounts of a proposed project for purposes of this paragraph, the1587
costs of all items subject to review by this chapter and items not subject to review by this1588
chapter associated with and simultaneously developed or proposed with the project shall1589
be counted, except for the expenditure or commitment of or incurring an obligation for1590 23 LC 33 9350
S. B. 162
- 62 -
the expenditure of funds to develop certificate of need applications, studies, reports,1591
schematics, preliminary plans and specifications or working drawings, or to acquire sites;1592
(20)  Expansion of services by an imaging center based on a population needs1593
methodology taking into consideration whether the population residing in the area served1594
by the imaging center has a need for expanded services, as determined by the department1595
in accordance with its rules and regulations, if such imaging center:1596
(A)  Was in existence and operational in this state on January 1, 2008;1597
(B)  Is owned by a hospital or by a physician or a group of physicians comprising at1598
least 80 percent ownership who are currently board certified in radiology;1599
(C)  Provides three or more diagnostic and other imaging services;1600
(D)  Accepts all patients regardless of ability to pay; and1601
(E)  Provides uncompensated indigent and charity care in an amount equal to or greater1602
than the amount of such care provided by the geographically closest general acute care1603
hospital; provided, however, that this paragraph shall not apply to an imaging center in1604
a rural county;1605
(21)  Diagnostic cardiac catheterization in a hospital setting on patients 15 years of age1606
and older;1607
(22)  Therapeutic cardiac catheterization in hospitals selected by the department prior to1608
July 1, 2008, to participate in the Atlantic Cardiovascular Patient Outcomes Research1609
Team (C-PORT) Study and therapeutic cardiac catheterization in hospitals that, as1610
determined by the department on an annual basis, meet the criteria to participate in the1611
C-PORT Study but have not been selected for participation; provided, however, that if1612
the criteria requires a transfer agreement to another hospital, no hospital shall1613
unreasonably deny a transfer agreement to another hospital;1614
(23)(14)  Facilities Infirmaries or facilities operated by, on behalf of, or under contract1615
with the Department of Corrections or the Department of Juvenile Justice for the sole and1616
exclusive purpose of providing health care services in a secure environment to prisoners1617 23 LC 33 9350
S. B. 162
- 63 -
within a penal institution, penitentiary, prison, detention center, or other secure
1618
correctional institution, including correctional institutions operated by private entities in1619
this state which house inmates under the Department of Corrections or the Department1620
of Juvenile Justice;1621
(24)
(15) The relocation of any skilled nursing facility, or intermediate care facility, or1622
micro-hospital within the same county, any other health care facility in a rural county1623
within the same county, and any other health care facility in an urban county within a1624
three-mile radius of the existing facility so long as the facility does not propose to offer1625
any new or expanded clinical health services at the new location; or1626
(25)  Facilities which are devoted to the provision of treatment and rehabilitative care for1627
periods continuing for 24 hours or longer for persons who have traumatic brain injury,1628
as defined in Code Section 37-3-1;1629
(26)  Capital expenditures for a project otherwise requiring a certificate of need if those1630
expenditures are for a project to remodel, renovate, replace, or any combination thereof,1631
a medical-surgical hospital and:1632
(A)  That hospital:1633
(i)  Has a bed capacity of not more than 50 beds;1634
(ii)  Is located in a county in which no other medical-surgical hospital is located;1635
(iii)  Has at any time been designated as a disproportionate share hospital by the1636
department; and1637
(iv)  Has at least 45 percent of its patient revenues derived from medicare, Medicaid,1638
or any combination thereof, for the immediately preceding three years; and1639
(B)  That project:1640
(i)  Does not result in any of the following:1641
(I)  The offering of any new clinical health services;1642
(II)  Any increase in bed capacity;1643
(III)  Any redistribution of existing beds among existing clinical health services; or1644 23 LC 33 9350
S. B. 162
- 64 -
(IV)  Any increase in capacity of existing clinical health services;1645
(ii)  Has at least 80 percent of its capital expenditures financed by the proceeds of a1646
special purpose county sales and use tax imposed pursuant to Article 3 of Chapter 81647
of Title 48; and1648
(iii)  Is located within a three-mile radius of and within the same county as the1649
hospital's existing facility;1650
(27)(16) The renovation, remodeling, refurbishment, or upgrading of a health care1651
facility, so long as the project does not result in any of the following:1652
(A)  The offering of any new or expanded clinical health services; or1653
(B)  Any increase in inpatient bed capacity;1654
(C)  Any redistribution of existing beds among existing clinical health services; or1655
(D)(B) A capital expenditure exceeding the threshold contained in paragraph (2) of1656
subsection (a) of Code Section 31-6-40;.1657
(28)  Other than for equipment used to provide positron emission tomography (PET)1658
services, the acquisition of diagnostic, therapeutic, or other imaging equipment with a1659
value of $3 million or less, by or on behalf of:1660
(A)  A hospital; or1661
(B)  An individual private physician or single group practice of physicians exclusively1662
for use on patients of such private physician or single group practice of physicians and1663
such private physician or member of such single group practice of physicians is1664
physically present at the practice location where the diagnostic or other imaging1665
equipment is located at least 75 percent of the time that the equipment is in use.1666
The amount specified in this paragraph shall not include build-out costs, as defined by1667
the department, but shall include all functionally related equipment, software, and any1668
warranty and services contract costs for the first five years.  The acquisition of one or1669
more items of functionally related diagnostic or therapeutic equipment shall be1670
considered as one project.  The dollar amount specified in this paragraph and in1671 23 LC 33 9350
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paragraph (10) of this subsection shall be adjusted annually by an amount calculated by1672
multiplying such dollar amounts (as adjusted for the preceding year) by the annual1673
percentage of change in the consumer price index, or its successor or appropriate1674
replacement index, if any, published by the United States Department of Labor for the1675
preceding calendar year, commencing on July 1, 2010; and1676
(29)  A capital expenditure of $10 million or less by a hospital at such hospital's primary1677
campus for:1678
(A)  The expansion or addition of the following clinical health services: operating1679
rooms, other than dedicated outpatient operating rooms; medical-surgical services;1680
gynecology; procedure rooms; intensive care; pharmaceutical services; pediatrics;1681
cardiac care or other general hospital services; provided, however, that such1682
expenditure does not include the expansion or addition of inpatient beds or the1683
conversion of one type of inpatient bed to another type of inpatient bed; or1684
(B)  The movement of clinical health services from one location on the hospital's1685
primary campus to another location on such hospital's primary campus.1686
(b)  By rule, the department shall establish a procedure for expediting or waiving reviews1687
of certain projects the nonreview of which it deems compatible with the purposes of this1688
chapter, in addition to expenditures exempted from review by this Code section.1689
31-6-47.1.1690
The department shall require prior notice from a new health care facility for approval of1691
any activity which is believed to be exempt pursuant to Code Section 31-6-47 or excluded1692
from the requirements of this chapter under other provisions of this chapter.  The1693
department may require prior notice and approval of any activity which is believed to be1694
exempt pursuant to paragraphs (10), (15), (16), (17), (20), (21), (23), (25), (26), (27), (28),1695
and (29) (12), (13), and (14) of subsection (a) of Code Section 31-6-47.  The department1696
shall establish timeframes, forms, and criteria to request a letter of determination that an1697 23 LC 33 9350
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activity is properly exempt or excluded under this chapter prior to its implementation.  The
1698
department shall publish notice of all requests for letters of determination regarding exempt1699
activity and opposition to such request.  Persons opposing a request for approval of an1700
exempt activity shall be entitled to file an objection with the department and the department1701
shall consider any filed objection when determining whether an activity is exempt.  After1702
the department's decision, an opposing party shall have the right to a fair hearing pursuant1703
to Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act,' on an adverse1704
decision of the department and judicial review of a final decision in the same manner and1705
under the same provisions as in Code Section 31-6-44.1.  If no objection to a request for1706
determination is filed within 30 days of the department's receipt of such request for1707
determination, the department shall have 60 days from the date of the department's receipt1708
of such request to review the request and issue a letter of determination.  The department1709
may adopt rules for deciding when it is not practicable to provide a determination in 601710
days and may extend the review period upon written notice to the requestor but only for an1711
extended period of no longer than an additional 30 days.1712
31-6-48.1713
The State Health Planning and Development Agency, the State-wide Health Coordinating1714
Council, and the State Health Planning Review Board existing immediately prior to1715
July 1, 1983, are abolished, and their respective successors on and after July 1, 1983, shall1716
be the Health Planning Agency, the Health Policy Council, and the Health Planning1717
Review Board, as established in this chapter, except that on and after July 1, 1991, the1718
Health Strategies Council shall be the successor to the Health Policy Council, and except1719
that on and after July 1, 1999, the Department of Community Health shall be the successor1720
to the Health Planning Agency, and except that on and after July 1, 2008, the Board of1721
Community Health shall be the successor to the duties of the Health Strategies Council1722
with respect to adoption of the state health plan, and except that on June 30, 2008, the1723 23 LC 33 9350
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- 67 -
Health Planning Review Board is abolished and the terms of all members on such board
1724
on such date shall automatically terminate and the Certificate of Need Appeal Panel shall1725
be the successor to the duties of the Health Planning Review Board on such date.  For1726
purposes of any existing contract with the federal government, or federal law referring to1727
such abolished agency, council, or board, the successor department, council, or board1728
established in this chapter or in Chapter 2 of this title shall be deemed to be the abolished1729
agency, council, or board and shall succeed to the abolished agency's, council's, or board's1730
functions.  The State Health Planning and Development Commission is abolished.1731
31-6-49.1732
All matters transferred to the Health Planning Agency by the previously existing provisions1733
of this Code section and that are in effect on June 30, 1999, shall automatically be1734
transferred to the Department of Community Health on July 1, 1999.  All matters of the1735
Health Planning Review Board that are pending on June 30, 2008, shall automatically be1736
transferred to the Certificate of Need Appeal Panel established pursuant to Code1737
Section 31-6-44.1738
31-6-50.1739
The review and appeal considerations and procedures set forth in Code Sections 31-6-421740
through 31-6-44, respectively, shall apply to and govern the review of capital expenditures1741
under the Section 1122 program of the federal Social Security Act of 1935, as amended,1742
including, but not limited to, any application for approval under Section 1122 which is1743
under consideration by the Health Planning Agency or on appeal before the Certificate of1744
Need Appeal Panel, successor to the former Health Planning Review Board as of June 30,1745
2008.1746 23 LC 33 9350
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ARTICLE 4
1747
31-6-70.1748
(a)  There shall be required from each health care facility in this state requiring a certificate1749
of need and all ambulatory surgical centers and imaging centers, whether or not exempt
1750
from obtaining a certificate of need under this chapter, an annual report of such health care1751
information as determined by the department.  The report shall be due on the date1752
determined by the department and shall cover the 12 month period preceding each such1753
calendar year.1754
(b)  The report required under subsection (a) of this Code section shall contain the1755
following information:1756
(1)  Total gross revenues;1757
(2)  Bad debts;1758
(3)  Amounts of free care extended, excluding bad debts;1759
(4)  Contractual adjustments;1760
(5)  Amounts of care provided under a Hill-Burton commitment;1761
(6)  Amounts of charity care provided to indigent and nonindigent persons;1762
(7)  Amounts of outside sources of funding from governmental entities, philanthropic1763
groups, or any other source, including the proportion of any such funding dedicated to the1764
care of indigent persons; and1765
(8)  For cases involving indigent persons and nonindigent person persons receiving1766
charity care:1767
(A)  The number of persons treated;1768
(B)  The number of inpatients and outpatients;1769
(C)  Total patient days;1770
(D)  The number of patients categorized by county of residence; and1771 23 LC 33 9350
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(E)  The indigent and nonindigent care costs incurred by the health care facility by
1772
county of residence;
1773
(9)  Transfers to a hospital or hospital emergency department, including both direct1774
transfers and transfers by emergency medical services;1775
(10)  Number of rooms, beds, procedures, and patients, including, without limitation,1776
demographic information and payer source;1777
(11)  Patient origin by county; and1778
(12)  Operational information such as procedure types, volumes, and charges.1779
(c)  As used in subsection (b) of this Code section, the term 'indigent persons' means1780
persons having as a maximum allowable income level an amount corresponding to 1251781
percent of the federal poverty guideline.1782
(d)  The department shall provide a form for the reports required by this Code section and1783
may provide in said form for further categorical divisions of the information listed in1784
subsection (b) or (c.1) of this Code section.1785
(e)(1)  In the event the department does not receive an annual report from a health care1786
facility requiring a certificate of need or an ambulatory surgical center or imaging center,1787
whether or not exempt from obtaining a certificate of need under this chapter, on or1788
before the date such report was due or receives a timely but incomplete report, the1789
department shall notify the health care facility or center regarding the deficiencies and1790
shall be authorized to fine such health care facility or center an amount not to exceed1791
$500.00 per day for every day up to 30 days and $1,000.00 per day for every day over 301792
days for every day of such untimely or deficient report.1793
(2)  In the event the department does not receive an annual report from a health care1794
facility within 180 days following the date such report was due or receives a timely but1795
incomplete report which is not completed within such 180 days, the department shall be1796
authorized to revoke such health care facility's certificate of need in accordance with1797
Code Section 31-6-45.1798 23 LC 33 9350
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(f)  No application for a certificate of need under Article 3 of this chapter shall be
1799
considered as complete if the applicant has not submitted the annual report required by1800
subsection (a) of this Code section.1801
(g)  The department shall make publicly available all annual reports submitted pursuant to1802
this Code section on the department website.  The department shall also provide a copy of1803
such annual reports to the Governor, the President of the Senate, the Speaker of the House1804
of Representatives, and the chairpersons of the House Committee on Health and Human
1805
Services and the Senate Health and Human Services Committee.1806
(h)  All health care facilities, ambulatory surgical centers, and imaging centers required to1807
submit an annual report pursuant to subsection (a) of this Code section shall make such1808
annual reports publicly available on their websites."1809
PART II1810
SECTION 2-1.1811
Said title is further amended by adding a new chapter to read as follows:1812
"CHAPTER 6A1813
31-6A-1.1814
As used in this chapter, the term:1815
(1)  'Ambulatory surgical center' means a public or private facility, not a part of a1816
hospital, which meets the criteria contained in subparagraph (C) of paragraph (4) of Code1817
Section 31-7-1; provided, however, that if a private facility, at least 51 percent must be1818
owned directly or indirectly by a hospital or a physician or physicians licensed to practice1819
in Georgia.1820 23 LC 33 9350
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(2)  'Bed capacity' means space used exclusively for inpatient care, including space1821
designed or remodeled for inpatient beds even though temporarily not used for such1822
purposes.  The number of beds to be counted in any patient room shall be the maximum1823
number for which adequate square footage is provided as established by rules of the1824
department, except that single beds in single rooms shall be counted even if the room1825
contains inadequate square footage.1826
(3)  'Board' means the Board of Community Health.1827
(4)  'Clinical health services' means diagnostic, treatment, or rehabilitative services1828
provided in a health care facility, or parts of the physical plant where such services are1829
located in a health care facility, and includes, but is not limited to, the following:1830
radiation therapy; biliary lithotripsy; surgery; intensive care; coronary care; pediatrics;1831
gynecology; obstetrics; general medical care; medical/surgical care; inpatient nursing1832
care, whether intermediate, skilled, or extended care; cardiac catheterization; open-heart1833
surgery; and inpatient rehabilitation.1834
(5)  'Commissioner' means the commissioner of community health.1835
(6)  'Department' means the Department of Community Health established under Chapter1836
2 of this title.1837
(7)  'Destination cancer hospital' means an institution with a licensed bed capacity of 501838
or fewer which provides diagnostic, therapeutic, treatment, and rehabilitative care1839
services to cancer inpatients and outpatients, by or under the supervision of physicians,1840
and whose proposed annual patient base is composed of a minimum of 65 percent of1841
patients who reside outside of this state.1842
(8)  'Develop,' with reference to a project, means constructing, remodeling, installing, or1843
proceeding with a project, or any part of a project, or a capital expenditure project, the1844
cost estimate for which exceeds $3,068,601.00.  The dollar amount specified in this1845
paragraph shall be adjusted annually by an amount calculated by the department to reflect1846
inflation, which may be calculated by multiplying such dollar amount, as adjusted for the1847 23 LC 33 9350
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preceding year, by the annual percentage of change in the composite index of1848
construction material prices, or its successor or appropriate replacement index, if any,1849
published by the United States Department of Commerce for the preceding calendar year,1850
commencing on July 1, 2023, and on each anniversary thereafter of the publication of the1851
index.  The department shall immediately institute rule-making procedures to adopt such1852
adjusted dollar amounts.  In calculating the dollar amount of a proposed project for1853
purposes of this paragraph, the costs of all items subject to review by this chapter and1854
items not subject to review by this chapter associated with and simultaneously developed1855
or proposed with the project shall be counted; provided, however, that the expenditure1856
or commitment or incurring an obligation for the expenditure of funds to develop special1857
health care services license applications, studies, reports, schematics, preliminary plans1858
and specifications, or working drawings or to acquire, develop, or prepare sites shall not1859
be considered to be the developing of a project.1860
(9)  'Diagnostic imaging' means magnetic resonance imaging, computed tomography1861
(CT) scanning, positron emission tomography (PET), positron emission1862
tomography/computed tomography, X-rays, fluoroscopy, or ultrasound services, and1863
other imaging services as defined by the department by rule.1864
(10)  'Diagnostic, treatment, or rehabilitation center' means any professional or business1865
undertaking, whether for profit or not for profit, which offers or proposes to offer any1866
clinical health service in a setting which is not part of a hospital; provided, however, that1867
any such diagnostic, treatment, or rehabilitation center that offers or proposes to offer1868
surgery in an operating room environment and to allow patients to remain more than 231869
hours shall be considered a hospital for purposes of this chapter.1870
(11)  'Exception acknowledgment' means a written notice from the department confirming1871
that a person is exempt from the requirements of this chapter pursuant to subsection (b)1872
of Code Section 31-6A-3 or pursuant to subsection (b) or (d) of Code Section 31-6A-10.1873 23 LC 33 9350
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- 73 -
(12)  'Health care facility' means hospitals; other special care units, including, but not1874
limited to, podiatric facilities; ambulatory surgical centers; health maintenance1875
organizations; and diagnostic, treatment, or rehabilitation centers, but only to the extent1876
subparagraph (a)(3)(B) of Code Section 31-6A-3 is applicable thereto.1877
(13)  'Health maintenance organization' means a public or private organization organized1878
under the laws of this state which:1879
(A)  Provides or otherwise makes available to enrolled participants health care services,1880
including at least the following basic health care services: usual physicians' services,1881
hospitalization, laboratory, X-ray, emergency and preventive services, and out-of-area1882
coverage;1883
(B)  Is compensated, except for copayments, for the provision of the basic health care1884
services listed in subparagraph (A) of this paragraph to enrolled participants on a1885
predetermined periodic rate basis; and1886
(C)  Provides physicians' services primarily:1887
(i)  Directly through physicians who are either employees or partners of such1888
organization; or1889
(ii)  Through arrangements with individual physicians organized on a group practice1890
or individual practice basis.1891
(14)  'Hospital' means an institution which is primarily engaged in providing to inpatients,1892
by or under the supervision of physicians, diagnostic services and therapeutic services for1893
medical diagnosis, treatment, and care of injured, disabled, or sick persons or1894
rehabilitation services for the rehabilitation of injured, disabled, or sick persons.  Such1895
term includes micro-hospitals and public, private, psychiatric, rehabilitative, geriatric,1896
osteopathic, and other specialty hospitals.1897
(15)  'Joint venture ambulatory surgical center' means a freestanding ambulatory surgical1898
center that is jointly owned by a hospital in the same county as the center or a hospital in1899
a contiguous county if there is no hospital in the same county as the center and a single1900 23 LC 33 9350
S. B. 162
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group of physicians practicing in the center and that provides surgery or where1901
cardiologists perform procedures in a single specialty as defined by the department;1902
provided, however, that general surgery, a group practice which includes one or more1903
physiatrists who perform services that are reasonably related to the surgical procedures1904
performed in the center, and a group practice in orthopedics which includes plastic hand1905
surgeons with a certificate of added qualifications in Surgery of the Hand from the1906
American Board of Plastic and Reconstructive Surgery shall be considered a single1907
specialty.  The ownership interest of the hospital shall be no less than 30 percent and the1908
collective ownership of the physicians or group of physicians shall be no less than 301909
percent.1910
(16)  'Micro-hospital' means a hospital in a rural county which has at least two and not1911
more than seven inpatient beds and which provides emergency services seven days per1912
week and 24 hours per day.1913
(17)  'Offer' means that the health care facility is open for the acceptance of patients or1914
performance of services and has qualified personnel, equipment, and supplies necessary1915
to provide specified clinical health services.1916
(18)  'Operating room environment' means an environment which meets the minimum1917
physical plant and operational standards specified in the rules of the department which1918
shall consider and use the design and construction specifications as set forth in the1919
Guidelines for Design and Construction of Health Care Facilities published by the1920
American Institute of Architects.1921
(19)  'Person' means any individual, trust or estate, partnership, limited liability company1922
or partnership, corporation (including associations, joint-stock companies, and insurance1923
companies), state, political subdivision, hospital authority, or instrumentality (including1924
a municipal corporation) of a state as defined in the laws of this state.  This term shall1925
include all related parties, including individuals, business corporations, general1926
partnerships, limited partnerships, limited liability companies, limited liability1927 23 LC 33 9350
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- 75 -
partnerships, joint ventures, nonprofit corporations, or any other for profit or not for profit1928
entity that owns or controls, is owned or controlled by, or operates under common1929
ownership or control with a person.1930
(20)  'Project' means a proposal to take an action for which a special health care services1931
license is required under this chapter.  A project or proposed project may refer to the1932
proposal from its earliest planning stages up through the point at which the new special1933
health care services are offered.1934
(21)  'Rural county' means a county having a population of less than 50,000 according to1935
the United States decennial census of 2010 or any future such census.1936
(22)  'Special health care services' means any facilities or services described in1937
paragraphs (1) through (4) of subsection (a) of Code Section 31-6A-3.1938
(23)  'Specialty ambulatory surgical center' means:1939
(A)  An ambulatory surgical center where surgery is performed or where cardiologists1940
perform procedures in the offices of an individual private physician or single group1941
practice of private physicians if such surgery or cardiology procedures are performed1942
in a facility that is owned, operated, and utilized by such physicians who also are of a1943
single specialty; provided, however, that general surgery, a group practice which1944
includes one or more physiatrists who perform services that are reasonably related to1945
the surgical procedures performed in the center, and a group practice in orthopedics1946
which includes plastic hand surgeons with a certificate of added qualifications in1947
Surgery of the Hand from the American Board of Plastic and Reconstructive Surgery1948
shall be considered a single specialty; or1949
(B)  A multispecialty physician group owning, operating, and utilizing no more than1950
three specialty ambulatory surgical centers located in the same or different counties in1951
which the group has provided medical services in a clinical office for at least five years1952
and which limits each center to a single specialty which may be different single1953 23 LC 33 9350
S. B. 162
- 76 -
specialties; provided, however, that the specialty ambulatory surgical centers may be1954
colocated.1955
(24)  'Specialty hospital' means a hospital that is primarily or exclusively engaged in the1956
care and treatment of one of the following: patients with a cardiac condition, patients with1957
an orthopedic condition, patients receiving a surgical procedure, or patients receiving any1958
other specialized category of services defined by the department.1959
(25)  'Uncompensated indigent or charity care' means the dollar amount of 'net1960
uncompensated indigent or charity care after direct and indirect (all) compensation' as1961
defined by, and calculated in accordance with, the department's Hospital Financial Survey1962
and related instructions.1963
(26)  'Urban county' means a county having a population equal to or greater than 50,0001964
according to the United States decennial census of 2010 or any future such census.1965
31-6A-2.1966
(a)  On and after January 1, 2024, no person shall operate or provide any new special health1967
care services without acquiring a special health care services license under this chapter1968
unless such person has an exception acknowledgment from the department.1969
(b)  The department shall adopt rules to specify:1970
(1)  The minimal requirements for quality and safety for patients receiving each special1971
health care service;1972
(2)  The procedure for applying for and maintaining a special health care services license,1973
including, but not limited to, the frequency of licensing inspections, submission of1974
information, and data to evaluate the performance and ongoing operation of services and1975
enforcement under this chapter;1976
(3)  The fees for applying for and maintaining a special health care services license in1977
order to fully offset the cost to the department, including consultant fees and other related1978 23 LC 33 9350
S. B. 162
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expenses necessary to process the application, and for any ongoing expenses to the1979
department for maintaining a special health care services license; and1980
(4)  The procedure and criteria for requesting and approving an exception1981
acknowledgment.1982
31-6A-3.1983
(a)  A special health care services license shall be required for:1984
(1)  The construction, development, or other establishment of a new health care facility;1985
(2)  Any increase in the bed capacity of a health care facility except as provided in1986
subsection (b) of this Code section;1987
(3)  Clinical health services which are offered in or through:1988
(A)  A health care facility, which were not offered on a regular basis in or through such1989
health care facility within the 12 month period prior to the time such services would be1990
offered; and1991
(B)  A diagnostic, treatment, or rehabilitation center, which were not offered on a1992
regular basis in or through such center within the 12 month period prior to the time such1993
services would be offered, but only if the clinical health services are any of the1994
following:1995
(i)  Radiation therapy;1996
(ii)  Biliary lithotripsy;1997
(iii)  Surgery in an operating room environment, including, but not limited to,1998
ambulatory surgery; and1999
(iv)  Cardiac catheterization; and2000
(4)  Any conversion or upgrading of any general acute care hospital to a specialty hospital2001
or of a facility such that it is converted from a type of facility not covered by this chapter2002
to any of the types of health care facilities which are covered by this chapter.2003
(b)  A special health care services license shall not be required for:2004 23 LC 33 9350
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(1)  Infirmaries operated by educational institutions for the sole and exclusive benefit of2005
students, faculty members, officers, or employees thereof;2006
(2)  Infirmaries or facilities operated by businesses for the sole and exclusive benefit of2007
officers or employees thereof, provided that such infirmaries or facilities make no2008
provision for overnight stay by persons receiving their services;2009
(3)  Institutions operated exclusively by the federal government or by any of its agencies;2010
(4)  Offices of private physicians or dentists whether for individual or group practice;2011
(5)  Religious, nonmedical health care institutions as defined in 42 U.S.C.2012
Section 1395x(ss)(1), listed and certified by a national accrediting organization;2013
(6)  Site acquisitions for health care facilities or preparation or development costs for2014
such sites prior to the decision to file an application for a special health care services2015
license;2016
(7)  Expenditures related to adequate preparation and development of an application for2017
a special health care services license;2018
(8)  The commitment of funds conditioned upon the obtaining of a special health care2019
services license;2020
(9)  Expenditures for the acquisition of existing health care facilities by stock or asset2021
purchase, merger, consolidation, or other lawful means unless the facilities are owned or2022
operated by or on behalf of a:2023
(A)  Political subdivision of this state;2024
(B)  Combination of such political subdivisions; or2025
(C)  Hospital authority, as defined in Article 4 of Chapter 7 of this title;2026
(10)  Expenditures for the restructuring of or for the acquisition by stock or asset2027
purchase, merger, consolidation, or other lawful means of an existing health care facility2028
which is owned or operated by or on behalf of any entity described in2029
subparagraph (A), (B), or (C) of paragraph (9) of this subsection only if such2030 23 LC 33 9350
S. B. 162
- 79 -
restructuring or acquisition is made by any entity described in subparagraph (A), (B),2031
or (C) of paragraph (9) of this subsection;2032
(11)  The purchase of a closing hospital or of a hospital that has been closed for no more2033
than 12 months by a hospital in a contiguous county to repurpose the facility as a2034
micro-hospital;2035
(12)  Expenditures for the purchase, lease, replacement, upgrade, or repair of diagnostic2036
imaging equipment, diagnostic or therapeutic equipment, or medical equipment or the2037
provision of diagnostic imaging services;2038
(13) Expenditures for the minor or major repair of a health care facility or a facility that2039
is exempt from the requirements of this chapter or parts thereof or services provided2040
therein;2041
(14)  Capital expenditures otherwise covered by this chapter required solely to eliminate2042
or prevent safety hazards as defined by federal, state, or local fire, building,2043
environmental, occupational health, or life safety codes or regulations, to comply with2044
licensing requirements of the department, or to comply with accreditation standards of2045
a nationally recognized health care accreditation body;2046
(15)  Cost overruns whose percentage of the cost of a project is equal to or less than the2047
cumulative annual rate of increase in the composite construction index, published by the2048
federal Bureau of the Census of the Department of Commerce, calculated from the date2049
of approval of the project;2050
(16)  Transfers from one health care facility to another such facility of major medical2051
equipment previously approved under or exempted from special health care services2052
license review, except where such transfer results in the institution of a new clinical2053
health service for which a special health care services license is required in the facility2054
acquiring said equipment;2055 23 LC 33 9350
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(17)  New special health care services provided by or on behalf of health maintenance2056
organizations or related health care facilities in circumstances defined by the department2057
pursuant to federal law;2058
(18)  Increases in the bed capacity of a hospital up to ten beds or 20 percent of capacity,2059
whichever is greater, in any consecutive two-year period, in a hospital that has2060
maintained an overall occupancy rate greater than 60 percent for the previous 12 month2061
period;2062
(19)  Expenditures for nonclinical projects, including parking lots, parking decks, and2063
other parking facilities; computer systems, software, and other information technology;2064
and medical office buildings;2065
(20)  Continuing care retirement communities, home health agencies, intermediate care2066
facilities, personal care homes, and skilled nursing facilities, as all such terms are defined2067
in Code Section 31-6-2;2068
(21)  Any specialty ambulatory surgical center that:2069
(A)  Has a hospital affiliation agreement with a hospital within a reasonable distance2070
from the facility or the medical staff at the center has admitting privileges or other2071
acceptable documented arrangements with such hospital to ensure the necessary backup2072
for the center for medical complications.  The center shall have the capability to transfer2073
a patient immediately to a hospital within a reasonable distance from the facility with2074
adequate emergency room services.  Hospitals shall not unreasonably deny a transfer2075
agreement or affiliation agreement to the center;2076
(B)  Provides care to Medicaid beneficiaries and, if the facility provides medical care2077
and treatment to children, to PeachCare for Kids beneficiaries and provides2078
uncompensated indigent and charity care in accordance with Code Section 31-6A-6;2079
provided, however, that specialty ambulatory surgical centers owned by physicians in2080
the practice of ophthalmology shall not be required to comply with this subparagraph;2081
and2082 23 LC 33 9350
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(C)  Provides annual reports in the same manner and in accordance with Code2083
Section 31-6A-7.2084
Noncompliance with any condition of this paragraph shall result in a monetary penalty2085
in the amount of the difference between the services which the center is required to2086
provide and the amount actually provided and may be subject to revocation of its2087
exemption status by the department for repeated failure to pay any fines or moneys due2088
to the department or for repeated failure to produce data as required by Code2089
Section 31-6A-7 after notice to the exemption holder and a fair hearing pursuant to2090
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'  Any penalty so2091
recovered shall be dedicated and deposited by the department into the Indigent Care Trust2092
Fund created pursuant to Code Section 31-8-152 for the purposes set out in Code2093
Section 31-8-154, including expanding Medicaid eligibility and services; programs to2094
support rural and other health care providers, primarily hospitals, who serve the medically2095
indigent; and for primary health care programs for medically indigent citizens and2096
children of this state;2097
(22)  Any joint venture ambulatory surgical center that:2098
(A)  Provides care to Medicaid beneficiaries and, if the facility provides medical care2099
and treatment to children, to PeachCare for Kids beneficiaries and provides2100
uncompensated indigent and charity care in accordance with Code Section 31-6A-6;2101
and2102
(B)  Provides annual reports in the same manner and in accordance with Code2103
Section 31-6A-7.2104
Noncompliance with any condition of this paragraph shall result in a monetary penalty2105
in the amount of the difference between the services which the center is required to2106
provide and the amount actually provided and may be subject to revocation of its2107
exemption status by the department for repeated failure to pay any fines or moneys due2108
to the department or for repeated failure to produce data as required by Code2109 23 LC 33 9350
S. B. 162
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Section 31-6A-7 after notice to the exemption holder and a fair hearing pursuant to2110
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'  Any penalty so2111
recovered shall be dedicated and deposited by the department into the Indigent Care Trust2112
Fund created pursuant to Code Section 31-8-152 for the purposes set out in Code2113
Section 31-8-154, including expanding Medicaid eligibility and services; programs to2114
support rural and other health care providers, primarily hospitals, who serve the medically2115
indigent; and for primary health care programs for medically indigent citizens and2116
children of this state;2117
(23)  Diagnostic cardiac catheterization in a hospital setting on patients 15 years of age2118
and older;2119
(24)  Therapeutic cardiac catheterization in hospitals selected by the department prior to2120
July 1, 2008, to participate in the Atlantic Cardiovascular Patient Outcomes Research2121
Team (C-PORT) Study and therapeutic cardiac catheterization in hospitals that, as2122
determined by the department on an annual basis, meet the criteria to participate in the2123
C-PORT Study but have not been selected for participation; provided, however, that if2124
the criteria requires a transfer agreement to another hospital, no hospital shall2125
unreasonably deny a transfer agreement to another hospital;2126
(25)  Infirmaries or facilities operated by, on behalf of, or under contract with the2127
Department of Corrections or the Department of Juvenile Justice for the sole and2128
exclusive purpose of providing health care services in a secure environment to prisoners2129
within a penal institution, penitentiary, prison, detention center, or other secure2130
correctional institution, including correctional institutions operated by private entities in2131
this state which house inmates under the Department of Corrections or the Department2132
of Juvenile Justice;2133
(26)  The relocation of any micro-hospital within the same county, any other health care2134
facility in a rural county within the same county, and any other health care facility in an2135 23 LC 33 9350
S. B. 162
- 83 -
urban county within a three-mile radius of the existing facility so long as the facility does2136
not propose to offer any new or expanded clinical health services at the new location;2137
(27)  Facilities which are devoted to the provision of treatment and rehabilitative care for2138
periods continuing for 24 hours or longer for persons who have traumatic brain injury,2139
as defined in Code Section 37-3-1;2140
(28)  Capital expenditures for a project otherwise requiring a special health care services2141
license if those expenditures are for a project to remodel, renovate, replace, or any2142
combination thereof, a medical-surgical hospital and:2143
(A)  That hospital:2144
(i)  Has a bed capacity of not more than 50 beds;2145
(ii)  Is located in a county in which no other medical-surgical hospital is located;2146
(iii)  Has at any time been designated as a disproportionate share hospital by the2147
department; and2148
(iv)  Has at least 45 percent of its patient revenues derived from medicare, Medicaid,2149
or any combination thereof, for the immediately preceding three years; and2150
(B)  That project:2151
(i)  Does not result in any of the following:2152
(I)  The offering of any new clinical health services;2153
(II)  Any increase in bed capacity;2154
(III)  Any redistribution of existing beds among existing clinical health services; or2155
(IV)  Any increase in capacity of existing clinical health services;2156
(ii)  Has at least 80 percent of its capital expenditures financed by the proceeds of a2157
special purpose county sales and use tax imposed pursuant to Article 3 of Chapter 82158
of Title 48; and2159
(iii)  Is located within a three-mile radius of and within the same county as the2160
hospital's existing facility;2161 23 LC 33 9350
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(29)  Public or private psychiatric hospitals; mental health or substance abuse facilities2162
or programs; or mental health or substance abuse services; and2163
(30)  A freestanding ambulatory surgical center with no more than six operating rooms2164
developed on the same site as a sports training and educational facility that includes2165
sports training facilities and fields; a medical education facility and program for2166
physicians and other health care professionals training in sports medicine; a medical2167
research program; ancillary services, including physical therapy and diagnostic imaging;2168
a community education program for student athletic programs on injury prevention and2169
treatment and related topics, and that provides uncompensated indigent or charity care2170
in accordance with Code Section 31-6A-6, provides care to Medicaid patients, and, if the2171
facility provides medical care and treatment to children, participates as a provider for2172
PeachCare for Kids beneficiaries; and demonstrates a positive economic impact of no less2173
than $25 million, taking into consideration the full-time and part-time jobs generated by2174
the initial construction and ongoing operation of the center, new state and local tax2175
revenue generated by the initial construction and ongoing operation of the center, and2176
other factors deemed relevant as determined by the department based on a report prepared2177
by an independent consultant or expert retained by the center.2178
31-6A-4.2179
(a)  An application for a special health care services license shall include:2180
(1)  Certification that the applicant is licensed or will seek licensure under Chapter 7 of2181
this title, if subject to the requirements of such chapter;2182
(2)  Certification that the applicant has notified the public of the intent to file the2183
application with a description of the facility or special health care services to be licensed2184
by publishing a notice in a newspaper of general circulation covering the area where the2185
service is to be located in at least two separate issues of the newspaper no less than ten2186
business days prior to the filing of the application;2187 23 LC 33 9350
S. B. 162
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(3)  Certification that the applicant has given written notice of the intent to file the2188
application by registered mail no less than ten business days prior to the filing of the2189
application to the chief executive officer of each existing facility that:2190
(A)  Is located within a ten-mile radius of the applicant's proposed new facility or2191
services;2192
(B)  Is the same type of facility or offers the same type of services as the proposed new2193
facility or services; and2194
(C)  Has a special health care services license issued pursuant to this chapter; and2195
(4)  Any other information deemed necessary by the department.2196
(b)  In addition to publication on the department's website, any application for a special2197
health care services license shall be available for inspection and copying by any person2198
immediately upon it being filed.2199
(c) Any complete application for a special health care services license shall be approved2200
by the department within 45 days of the filing of such application unless a timely objection2201
in writing to such application is received by the department in accordance with2202
subsection (a) of Code Section 31-6A-5.2203
31-6A-5.2204
(a)(1)  No written objection may be made to an application for a special health care2205
services license for a new special health care service located in a county within health2206
planning area three of the department's established health planning areas, as such exists2207
on June 30, 2023, unless an existing facility is located outside of health planning area2208
three but is within a ten-mile radius of the proposed new facility or services.2209
(2)  Except as provided in paragraph (1) of this subsection, a written objection to an2210
application for a special health care services license may be submitted by an existing2211
facility within 30 days of the filing of such application with the department, on the2212 23 LC 33 9350
S. B. 162
- 86 -
grounds that the application is not in the public interest of the community, if such existing2213
facility:2214
(A)  Is located within a ten-mile radius of the applicant's proposed new facility or2215
services;2216
(B)  Is the same type of facility or offers the same type of services as the proposed new2217
facility or services; and2218
(C)  Has a special health care services license issued pursuant to this chapter.2219
(b)  No later than 30 days of receipt of a timely written objection pursuant to paragraph (2)2220
of subsection (a) of this Code section, the commissioner shall conduct a public interest2221
review and make a written determination as to whether the application is in the public2222
interest of the community, taking into consideration any material adverse impact on the2223
objecting party or parties, unique health care needs of the community (not based on a2224
numerical need formula), atypical barriers or factors, whether the new special health care2225
services would foster competition or make services less costly or more accessible, and2226
whether the applicant performs or proposes to perform activities outside of inpatient or2227
outpatient care in the community for underserved populations.  The commissioner may not2228
deny an application based on an objection unless the objecting party shows by clear and2229
convincing evidence that the project does not meet the criteria set forth in this subsection.2230
(c)  If the special health care services license is granted by the department over a timely2231
objection, the person who objected shall have a right to request a fair hearing pursuant to2232
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'2233
(d)  If the special health care services license is denied by the department after a timely2234
objection, the applicant shall have a right to request a fair hearing pursuant to Chapter 132235
of Title 50, the 'Georgia Administrative Procedure Act.'2236
(e)  Any party to the initial administrative appeal hearing, excluding the department, may2237
seek judicial review of the final decision in accordance with the method set forth in2238
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'2239 23 LC 33 9350
S. B. 162
- 87 -
31-6A-6.2240
(a)  As a condition for special health care services licenses issued on and after2241
January 1, 2024, the department shall require that an applicant or licensee agrees:2242
(1)  To provide uncompensated indigent or charity care in an amount which meets or2243
exceeds the percentage of such applicant's adjusted gross revenues equivalent to:2244
(A)  The state-wide average of net uncompensated indigent and charity care provided2245
based on the previous two most recent years if a nonprofit entity; or2246
(B)  The state-wide average of net uncompensated indigent and charity care provided2247
based on the previous two most recent years less 3 percent if a for profit entity; and2248
(2)  To participate as a provider of medical assistance for Medicaid purposes, and, if the2249
facility provides medical care and treatment to children, to participate as a provider for2250
PeachCare for Kids beneficiaries.2251
(b)  A grantee or successor in interest for a special health care services license or an2252
authorization to operate under this chapter which violates such an agreement or violates2253
any conditions imposed by the department relating to such services shall be liable to the2254
department for a monetary penalty in the amount of 1 percent of its net revenue for every2255
0.5 percent of uncompensated indigent and charity care not provided and may be subject2256
to revocation of its special health care services license, in whole or in part, by the2257
department pursuant to Code Section 31-6A-8.  Any penalty so recovered shall be2258
dedicated and deposited by the department into the Indigent Care Trust Fund created2259
pursuant to Code Section 31-8-152 for the purposes set out in Code Section 31-8-154,2260
including expanding Medicaid eligibility and services; programs to support rural and other2261
health care providers, primarily hospitals, who serve the medically indigent; and for2262
primary health care programs for medically indigent citizens and children of this state.2263
(c)  Penalties authorized under this Code section shall be subject to the same notices and2264
hearing for the levy of fines under Code Section 31-6A-8.2265 23 LC 33 9350
S. B. 162
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(d)(1)  This Code section shall not apply to a hospital or any health care facilities owned2266
by a hospital or health care system that has a payer mix of greater than 40 percent2267
Medicaid recipients and uncompensated indigent and charity care of at least 2 percent;2268
provided, however, that a hospital's cost gap between its Medicaid reimbursement rate2269
and the Medicare reimbursement shall count toward such uncompensated indigent and2270
charity care amount.2271
(2)  As used in this subsection, the term 'payer mix' means the proportionate share of2272
itemized charges attributable to patients assignable to a specific payer classification to2273
total itemized charges for all patients.2274
(e)  The department may withhold all or any portion of disproportionate share hospital2275
funds to any hospital that is subject to the requirements contained in paragraph (1) of2276
subsection (a) of this Code section that fails to meet the minimum indigent and charity care2277
requirements for two consecutive years.2278
31-6A-7.2279
(a)  Each health care facility in this state that is required by the department to provide2280
uncompensated indigent or charity care pursuant to Code Section 31-6A-6 shall submit an2281
annual report of certain health care information to the department.  The report shall be due2282
on the last day of January and shall cover the 12 month period preceding each such2283
calendar year.2284
(b)  The annual report required under subsection (a) of this Code section shall contain the2285
following information:2286
(1)  Total gross revenues;2287
(2)  Bad debts;2288
(3)  Amounts of free care extended, excluding bad debts;2289
(4)  Contractual adjustments;2290
(5)  Amounts of care provided under a Hill-Burton commitment;2291 23 LC 33 9350
S. B. 162
- 89 -
(6)  Amounts of charity care provided to indigent persons;2292
(7)  Amounts of outside sources of funding from governmental entities, philanthropic2293
groups, or any other source, including the proportion of any such funding dedicated to the2294
care of indigent persons; and2295
(8)  For cases involving indigent persons:2296
(A)  The number of persons treated;2297
(B)  The number of inpatients and outpatients;2298
(C)  Total patient days;2299
(D)  The number of patients categorized by county of residence; and2300
(E)  The indigent care costs incurred by the health care facility by county of residence.2301
As used in this subsection, the term 'indigent persons' means persons having as a maximum2302
allowable income level an amount corresponding to 125 percent of the federal poverty2303
guideline.2304
(c)  The department shall provide a form for the report required by this Code section and2305
may provide in said form for further categorical divisions of the information listed in2306
subsection (b) of this Code section.2307
(d)(1)  In the event the department does not receive an annual report from an institution,2308
on or before the date such report was due or receives a timely but incomplete report, the2309
department shall notify the institution regarding the deficiencies and shall be authorized2310
to fine such institution an amount not to exceed $500.00 per day for every day up to 302311
days and $1,000.00 per day for every day over 30 days of such untimely or deficient2312
report.  Any fine so recovered shall be dedicated and deposited by the department into the2313
Indigent Care Trust Fund created pursuant to Code Section 31-8-152 for the purposes set2314
out in Code Section 31-8-154, including expanding Medicaid eligibility and services;2315
programs to support rural and other health care providers, primarily hospitals, who serve2316
the medically indigent; and for primary health care programs for medically indigent2317
citizens and children of this state.2318 23 LC 33 9350
S. B. 162
- 90 -
(2)  In the event the department does not receive an annual report from an institution2319
within 180 days following the date such report was due or receives a timely but2320
incomplete report which is not completed within such 180 days, the department shall be2321
authorized to revoke such institution's permit in accordance with Code Section 31-7-4.2322
31-6A-8.2323
(a)  The department may revoke a special health care services license, in whole or in part,2324
after notice to the holder of the special health care services license and a fair hearing2325
pursuant to Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act,' for the2326
following reasons:2327
(1)  Failure to comply with the provisions of this chapter;2328
(2)  The intentional provision of false information to the department by a licensee in that2329
licensee's application;2330
(3)  Repeated failure to pay any fines or moneys due to the department;2331
(4)  Failure to maintain minimum quality of care standards that may be established by the2332
department;2333
(5)  Failure to participate as a provider of medical assistance for Medicaid purposes or2334
the PeachCare for Kids Program, if applicable; or2335
(6)  The failure to submit a timely or complete report within 180 days following the date2336
the report is due pursuant to Code Section 31-6A-7.2337
(b)  In the event that a new special health care service is knowingly offered or developed2338
without having obtained a special health care services license as required by this chapter,2339
or the special health care services license for such service is revoked according to the2340
provisions of this Code section, a facility or applicant may be fined an amount of $5,000.002341
per day up to 30 days, $10,000.00 per day from 31 days through 60 days, and $25,000.002342
per day after 60 days for each day that the violation of this chapter has existed and2343
knowingly and willingly continues; provided, however, that the expenditure or2344 23 LC 33 9350
S. B. 162
- 91 -
commitment of or incurring an obligation for the expenditure of funds to take or perform2345
actions not subject to this chapter or to acquire, develop, or prepare a health care facility2346
site for which a special health care services license application is denied shall not be a2347
violation of this chapter and shall not be subject to such a fine.  The commissioner shall2348
determine, after notice and a hearing, whether the fines provided in this Code section shall2349
be levied.  Any fine so recovered shall be dedicated and deposited by the department into2350
the Indigent Care Trust Fund created pursuant to Code Section 31-8-152 for the purposes2351
set out in Code Section 31-8-154, including expanding Medicaid eligibility and services;2352
programs to support rural and other health care providers, primarily hospitals, who serve2353
the medically indigent; and for primary health care programs for medically indigent2354
citizens and children of this state.2355
(c)  In addition, for purposes of this Code section, the State of Georgia, acting by and2356
through the department, or any other interested person, shall have standing in any court of2357
competent jurisdiction to maintain an action for injunctive relief to enforce the provisions2358
of this chapter.2359
(d)  The department shall have the authority to make public or private investigations or2360
examinations inside or outside of this state to determine whether any provisions of this2361
chapter or any other law, rule, regulation, or formal order relating to the provision of2362
special health care services has been violated.  Such investigations may be initiated at any2363
time in the discretion of the department and may continue during the pendency of any2364
action initiated by the department pursuant to this Code section.  For the purpose of2365
conducting any investigation or inspection pursuant to this subsection, the department shall2366
have the authority, upon providing reasonable notice, to require the production of any2367
books, records, papers, or other information related to any special health care services2368
license issue.2369 23 LC 33 9350
S. B. 162
- 92 -
31-6A-9.2370
Any person who acquires a health care facility by stock or asset purchase, merger,2371
consolidation, or other lawful means shall notify the department of such acquisition, the2372
date thereof, and the name and address of the acquiring person.  Such notification shall be2373
made in writing to the department within 45 days following the acquisition and the2374
acquiring person may be fined by the department in the amount of $500.00 for each day2375
that such notification is late.  Such fine shall be paid into the state treasury.  Any fine so2376
recovered shall be dedicated and deposited by the department into the Indigent Care Trust2377
Fund created pursuant to Code Section 31-8-152 for the purposes set out in Code2378
Section 31-8-154, including expanding Medicaid eligibility and services; programs to2379
support rural and other health care providers, primarily hospitals, who serve the medically2380
indigent; and for primary health care programs for medically indigent citizens and children2381
of this state.2382
31-6A-10.2383
(a)  Except as provided in subsection (c) of this Code section, on and after January 1, 2024,2384
health care facilities, as defined in Code Section 31-6A-1, shall not be subject to the former2385
provisions of Chapter 6 of this title, as such existed on December 31, 2023, and shall not2386
be required to obtain or retain a certificate of need in order to operate, but all such valid2387
certificates of need in existence on December 31, 2023, shall be converted by operation of2388
law to special health care services licenses and all such license holders shall be subject to2389
the provisions of this chapter on and after such date; provided, however, that such health2390
care facilities shall not be subject to the requirements of Code Section 31-6A-6 but shall2391
instead be subject to any conditions previously imposed by the department relating to2392
indigent or charity care and participation as a Medicaid provider that were in effect on2393
December 31, 2023, pursuant to the former provisions of Chapter 6 of this title, as such2394
existed on December 31, 2023.  The department may withhold all or any portion of2395 23 LC 33 9350
S. B. 162
- 93 -
disproportionate share hospital funds to any hospital exempt pursuant to this subsection2396
that fails to meet any conditions previously imposed by the department relating to indigent2397
and charity care for two consecutive years.  In the event a health care facility operating2398
pursuant to this subsection receives any modification of its special health care services2399
license, it shall immediately become subject to the requirements contained in Code Section2400
31-6A-6 in lieu of the conditions previously imposed by the department relating to indigent2401
or charity care and participation as a Medicaid provider or PeachCare for Kids Program2402
provider that were in effect on December 31, 2023.2403
(b)(1)  On and after January 1, 2024, any person who had a valid exemption from2404
certificate of need requirements under the former provisions of Chapter 6 of this title, as2405
such existed on December 31, 2023, shall not be required to obtain or retain a special2406
health care services license under this chapter in order to operate, but any such valid2407
exemption in existence on December 31, 2023, shall be converted by operation of law to2408
an exemption to special health care services license requirements under this chapter but2409
shall be subject to any conditions previously imposed pursuant to the former provisions2410
of Chapter 6 of this title, as such existed on December 31, 2023.2411
(2)  In the event a person that is exempt pursuant to paragraph (1) of this subsection2412
makes any modification to the special health care services it provides, it shall2413
immediately become subject to the requirements contained in Code Section 31-6A-6 in2414
lieu of the conditions previously imposed by the department relating to indigent or charity2415
care and participation as a Medicaid provider or PeachCare for Kids Program provider2416
that were in effect on December 31, 2023.2417
(c)(1)  On and after January 1, 2024, a destination cancer hospital that was granted a2418
certificate of need pursuant to the former provisions of Chapter 6 of this title, as such2419
existed on December 31, 2023, may convert to a hospital by notifying the department in2420
writing as to the date of conversion.  Upon such conversion, the hospital may continue2421
to provide all institutional health services and other services it provided as of the date of2422 23 LC 33 9350
S. B. 162
- 94 -
such conversion, including, but not limited to, inpatient beds, outpatient services, surgery,2423
radiation therapy, imaging, and positron emission tomography (PET) scanning, without2424
any further approval from the department; provided, however, that upon such conversion,2425
such hospital shall immediately become subject to the requirements of Code2426
Section 31-6A-6.  On and after the date of conversion, the hospital shall be classified as2427
a hospital under this chapter and shall be subject to all requirements and conditions for2428
any new special health care services license requirements, exemptions, and for all other2429
purposes, except as otherwise provided herein.2430
(2)  In the event that a destination cancer hospital does not convert to a hospital, it shall2431
remain subject to all requirements and conditions previously in effect as of2432
December 31, 2023, under the provisions of Chapter 6 of this title as they existed on such2433
date.2434
(d)  Any outstanding appeals before the Certificate of Need Appeal Panel as of2435
December 31, 2023, relating to health care facilities, as defined in Code Section 31-6A-1,2436
shall be deemed moot and dismissed by operation of law as of January 1, 2024.2437
31-6A-11.2438
The department shall be authorized to promulgate rules and regulations to implement the2439
provisions of this chapter."2440
PART III2441
SECTION 3-1.2442
Said title is further amended in Article 2 of Chapter 7, relating to the Georgia Building2443
Authority, by redesignating Code Section 31-7-24 as Code Section 31-7-25 and by adding2444
a new Code section to the end of Article 1, relating to regulation of hospitals and related2445
institutions, to read as follows:2446 23 LC 33 9350
S. B. 162
- 95 -
"31-7-24.2447
(a)  As used in this Code section, the term:2448
(1)  'Hospital' shall have the same meaning as in Code Section 31-7-22.2449
(2)  'Medical use rights' means rights or interests in real property in which the owner of2450
the property has agreed not to sell or lease such real property for identified medical uses2451
or purposes.2452
(b)  It shall be unlawful for any hospital to purchase, renew, extend, lease, maintain, or hold2453
medical use rights.2454
(c)  This Code section shall not be construed to impair any contracts in existence as of the2455
effective date of this Code section."2456
SECTION 3-2.2457
Code Section 50-18-70 of the Official Code of Georgia Annotated, relating to legislative2458
intent and definitions relative to open records laws, is amended by revising subsection (b)2459
as follows:2460
"(b)  As used in this article, the term:2461
(1)  'Agency' shall have the same meaning as in Code Section 50-14-1 and shall2462
additionally include any association, corporation, or other similar organization that has2463
a membership or ownership body composed primarily of counties, municipal2464
corporations, or school districts of this state, their officers, or any combination thereof2465
and derives more than 33 1/3 percent of its general operating budget from payments from2466
such political subdivisions.  Such term shall also include any nonprofit organization to2467
which is leased and transferred hospital assets of a hospital authority through a corporate2468
restructuring and any subsidiaries or foundations established by such nonprofit2469
organization in furtherance of the public mission of the hospital authority.2470
(2)  'Public record' means all documents, papers, letters, maps, books, tapes, photographs,2471
computer based or generated information, data, data fields, or similar material prepared2472 23 LC 33 9350
S. B. 162
- 96 -
and maintained or received by an agency or by a private person or entity in the
2473
performance of a service or function for or on behalf of an agency or when such2474
documents have been transferred to a private person or entity by an agency for storage2475
or future governmental use, including, but not limited to, any such material in the
2476
possession or control of a nonprofit organization to which is leased and transferred2477
hospital assets of a hospital authority through a corporate restructuring which are related2478
to the operation of the hospital and other leased facilities in the performance of services2479
on behalf of the hospital authority."2480
PART IV2481
SECTION 4-1.2482
Title 31 of the Official Code of Georgia Annotated, relating to health, is amended in Code2483
Section 31-7-3, relating to requirements for permits to operate institutions, by revising2484
subsection (a) as follows:2485
"(a)  Any person or persons responsible for the operation of any institution, or who may2486
hereafter propose to establish and operate an institution and to provide specified clinical2487
services, shall submit an application to the department for a permit to operate the institution2488
and provide such services, with such application to be made on forms prescribed by the2489
department.  No institution shall be operated in this state without such a permit, which shall2490
be displayed in a conspicuous place on the premises.  No clinical services shall be provided2491
by an institution except as approved by the department in accordance with the rules and2492
regulations established pursuant to Code Section 31-7-2.1.  Failure or refusal to file an2493
application for a permit shall constitute a violation of this chapter and shall be dealt with2494
as provided for in Article 1 of Chapter 5 of this title.  Following inspection and2495
classification of the institution for which a permit is applied for, the department may issue2496
or refuse to issue a permit or a provisional permit.  Permits issued shall remain in force and2497 23 LC 33 9350
S. B. 162
- 97 -
effect until revoked or suspended; provisional permits issued shall remain in force and
2498
effect for such limited period of time as may be specified by the department.  Upon2499
conclusion of the Atlantic Cardiovascular Patient Outcomes Research Team (C-PORT)2500
Study, the department shall consider and analyze the data and conclusions of the study and2501
promulgate rules pursuant to Code Section 31-7-2.1 to regulate the quality of care for2502
therapeutic cardiac catheterization.  All hospitals that participated in the study and are
 were2503
exempt from obtaining a certificate of need based on paragraph (22) of subsection (a) of2504
former Code Section 31-6-47 as it existed on December 31, 2023, shall apply for a permit2505
to continue providing therapeutic cardiac catheterization services once the department2506
promulgates the rules required by this Code section."2507
SECTION 4-2.2508
Said title is further amended in Code Section 31-7-75, relating to the functions and powers2509
of county and municipal hospital authorities, by revising paragraph (24) as follows:2510
"(24)  To provide management, consulting, and operating services including, but not2511
limited to, administrative, operational, personnel, and maintenance services to another2512
hospital authority, hospital, health care facility, as said term is defined in Chapter 6 of this2513
title Code Section 31-6A-1, person, firm, corporation, or any other entity or any group2514
or groups of the foregoing; to enter into contracts alone or in conjunction with others to2515
provide such services without regard to the location of the parties to such transactions;2516
to receive management, consulting, and operating services, including, but not limited to,2517
administrative, operational, personnel, and maintenance services from another such2518
hospital authority, hospital, health care facility, person, firm, corporation, or any other2519
entity or any group or groups of the foregoing; and to enter into contracts alone or in2520
conjunction with others to receive such services without regard to the location of the2521
parties to such transactions;"2522 23 LC 33 9350
S. B. 162
- 98 -
SECTION 4-3.
2523
Said title is further amended in Code Section 31-7-94.1, the "Rural Hospital Organization2524
Assistance Act of 2017," by revising paragraph (1) of subsection (e) as follows:2525
"(1)  Infrastructure development, including, without being limited to, health information2526
technology, facility renovation, or equipment acquisition; provided, however, that the
2527
amount granted to any qualified hospital may not exceed the expenditure thresholds that2528
would constitute a new institutional health service requiring a certificate of need under2529
Chapter 6 of this title and the grant award may be conditioned upon obtaining local2530
matching funds;"2531
SECTION 4-4.2532
Said title is further amended in Code Section 31-7-116, relating to provisions contained in2533
obligations and security for obligations, procedures for issuance of bonds and bond2534
anticipation notes, interest rates, and limitations and conditions, by revising subsection (i)2535
as follows:2536
"(i)  No bonds or bond anticipation notes except refunding bonds shall be issued by an2537
authority under this article unless its board of directors shall adopt adopts a resolution2538
finding that the project for which such bonds or notes are to be issued will promote the2539
objectives stated in subsection (b) of Code Section 31-7-111 and will increase or maintain2540
employment in the territorial area of such authority.  Nothing contained in this Code2541
section shall be construed as permitting any authority created under this article or any2542
qualified sponsor to finance, construct, or operate any project without obtaining any2543
certificate of need or other approval, permit, or license which, under the laws of this state,2544
is required in connection therewith."2545 23 LC 33 9350
S. B. 162
- 99 -
SECTION 4-5.
2546
Said title is further amended by revising Code Section 31-8-153.1, relating to irrevocable2547
transfer of funds to trust fund and provision for indigent patients, as follows:2548
"31-8-153.1.2549
After June 30, 1993, any hospital authority, county, municipality, or other state or local2550
public or governmental entity is authorized to transfer moneys to the trust fund.  Transfer2551
of funds under the control of a hospital authority, county, municipality, or other state or2552
local public or governmental entity shall be a valid public purpose for which those funds2553
may be expended.  The department is authorized to transfer to the trust fund moneys paid2554
to the state by a health care facility as a monetary penalty for the violation of an agreement2555
to provide a specified amount of clinical health services to indigent patients
 uncompensated2556
indigent or charity care pursuant to a certificate of need license held by such facility.  Such2557
transfers shall be irrevocable and shall be used only for the purposes contained in Code2558
Section 31-8-154."2559
SECTION 4-6.2560
Said title is further amended in Code Section 31-11-100, relating to definitions relative to the2561
Georgia Trauma Care Network Commission, by revising paragraph (3) as follows:2562
"(3)  'Trauma center' means a facility designated by the Department of Public Health as2563
a Level I, II, III, or IV or burn trauma center.  However, a burn trauma center shall not2564
be considered or treated as a trauma center for purposes of certificate of need2565
requirements under state law or regulations, including exceptions to need and adverse2566
impact standards allowed by the department for trauma centers or for purposes of2567
identifying safety net hospitals."2568 23 LC 33 9350
S. B. 162
- 100 -
SECTION 4-7.
2569
Code Section 37-1-29 of the Official Code of Georgia Annotated, relating to crisis2570
stabilization units, is amended by revising subsection (j) as follows:2571
"(j)  Any program certified as a crisis stabilization unit pursuant to this Code section shall
2572
be exempt from the requirements to obtain a certificate of need pursuant to Article 3 of2573
Chapter 6 of Title 31. Reserved."2574
SECTION 4-8.2575
Code Section 43-26-7 of the Official Code of Georgia Annotated, relating to requirements2576
for licensure as a registered professional nurse, is amended by revising paragraph (4) of2577
subsection (c) as follows:2578
"(4)(A)(i) Meet continuing competency requirements as established by the board;2579
(B)(ii) If the applicant entered a nontraditional nursing education program as a2580
licensed practical nurse whose academic education as a licensed practical nurse2581
included clinical training in pediatrics, obstetrics and gynecology, medical-surgical,2582
and mental illness, have practiced nursing as a registered professional nurse in a2583
health care facility for at least one year in the three years preceding the date of the2584
application, and such practice is documented by the applicant and approved by the2585
board; provided, however, that for an applicant who does not meet the experience2586
requirement of this subparagraph, the board shall require the applicant to complete a2587
320 hour postgraduate preceptorship arranged by the applicant under the oversight of2588
a registered nurse where such applicant is transitioned into the role of a registered2589
professional nurse.  The preceptorship shall have prior approval of the board, and2590
successful completion of the preceptorship shall be verified in writing by the2591
preceptor; or2592
(C)(iii) If the applicant entered a nontraditional nursing education program as2593
anything other than a licensed practical nurse whose academic education as a licensed2594 23 LC 33 9350
S. B. 162
- 101 -
practical nurse included clinical training in pediatrics, obstetrics and gynecology,
2595
medical-surgical, and mental illness, have graduated from such program and practiced2596
nursing as a registered professional nurse in a health care facility for at least two years2597
in the five years preceding the date of the application, and such practice is2598
documented by the applicant and approved by the board; provided, however, that for2599
an applicant who does not meet the experience requirement of this subparagraph
2600
subdivision, the board shall require the applicant to complete a postgraduate2601
preceptorship of at least 480 hours but not more than 640 hours, as determined by the2602
board, arranged by the applicant under the oversight of a registered professional nurse2603
where such applicant is transitioned into the role of a registered professional nurse.2604
The preceptorship shall have prior approval of the board, and successful completion2605
of the preceptorship shall be verified in writing by the preceptor.2606
(B) For purposes of this paragraph, the term 'health care facility' means an acute care2607
inpatient facility, a long-term acute care facility, an ambulatory surgical center or2608
obstetrical facility as defined in Code Section 31-6-2 31-6A-1, and a skilled nursing2609
facility, so long as such skilled nursing facility has 100 beds or more and provides2610
health care to patients with similar health care needs as those patients in a long-term2611
acute care facility;"2612
PART V2613
SECTION 5-1.2614
For purposes of rule-making, this Act shall become effective upon its approval by the2615
Governor or upon its becoming law without such approval.  For all other purposes, this Act2616
shall become effective on January 1, 2024.2617 23 LC 33 9350
S. B. 162
- 102 -
SECTION 5-2.
2618
All laws and parts of laws in conflict with this Act are repealed.2619