23 LC 33 9433S
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The Senate Committee on Regulated Industries and Utilities offered the following
substitute to SB 162:
A BILL TO BE ENTITLED
AN ACT
To amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to1
repeal certificate of need; to provide for a special health care services license for other health2
care facilities and services; to provide for definitions; to provide for requirements; to provide3
for exceptions; to provide for applications; to provide for notice and timely objections; to4
require the provision of indigent and charity care and Medicaid services; to provide for5
revocation; to require annual reports; to provide for rules and regulations; to provide for6
transition and grandfather provisions; to provide for the posting of certain documents on7
hospital websites; to amend Code Section 50-18-70 of the Official Code of Georgia8
Annotated, relating to legislative intent and definitions relative to open records laws, so as9
to revise definitions; to amend other provisions in various titles of the Official Code of10
Georgia Annotated for purposes of conformity; to provide for related matters; to provide for11
effective dates; to repeal conflicting laws; and for other purposes.12
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:13 23 LC 33 9433S
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PART I14
SECTION 1-1.15
Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by16
repealing Chapter 6, relating to state health planning and development, and by designating17
such chapter as reserved.18
PART II19
SECTION 2-1.20
Said title is further amended by adding a new chapter to read as follows:21
"CHAPTER 6A22
31-6A-1.23
As used in this chapter, the term:24
(1) 'Ambulatory surgical center' means a public or private facility, not a part of a25
hospital, which meets the criteria contained in subparagraph (C) of paragraph (4) of Code26
Section 31-7-1; provided, however, that if a private facility, at least 51 percent must be27
owned directly or indirectly by a hospital or a physician or physicians licensed to practice28
in Georgia.29
(2) 'Bed capacity' means space used exclusively for inpatient care, including space30
designed or remodeled for inpatient beds even though temporarily not used for such31
purposes. The number of beds to be counted in any patient room shall be the maximum32
number for which adequate square footage is provided as established by rules of the33
department, except that single beds in single rooms shall be counted even if the room34
contains inadequate square footage.35 23 LC 33 9433S
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(3) 'Board' means the Board of Community Health.36
(4) 'Clinical health services' means diagnostic, treatment, or rehabilitative services37
provided in a health care facility and includes, but is not limited to, the following:38
radiology and diagnostic imaging, such as magnetic resonance imaging and positron39
emission tomography (PET); radiation therapy; biliary lithotripsy; surgery; intensive care;40
coronary care; pediatrics; gynecology; obstetrics; general medical care; medical-surgical41
care; inpatient nursing care, whether intermediate, skilled, or extended care; cardiac42
catheterization; open heart surgery; inpatient rehabilitation; and alcohol, drug abuse, and43
mental health services.44
(5) 'Commissioner' means the commissioner of community health.45
(6) 'Department' means the Department of Community Health established under Chapter46
2 of this title.47
(7) 'Develop,' with reference to a project, means constructing, remodeling, installing, or48
proceeding with a project, or any part of a project, or a capital expenditure project, the49
cost estimate for which exceeds $10 million. Notwithstanding the provisions of this50
paragraph, the expenditure or commitment or incurring an obligation for the expenditure51
of funds to develop certificate of need applications, studies, reports, schematics,52
preliminary plans and specifications, or working drawings or to acquire, develop, or53
prepare sites shall not be considered to be the developing of a project.54
(8) 'Diagnostic imaging' means magnetic resonance imaging, computed tomography55
(CT) scanning, positron emission tomography (PET), positron emission56
tomography/computed tomography, X-rays, fluoroscopy, or ultrasound services, and57
other imaging services as defined by the department by rule.58
(9) 'Diagnostic, treatment, or rehabilitation center' means any professional or business59
undertaking, whether for profit or not for profit, which offers or proposes to offer any60
clinical health service in a setting which is not part of a hospital; provided, however, that61
any such diagnostic, treatment, or rehabilitation center that offers or proposes to offer62 23 LC 33 9433S
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surgery in an operating room environment and to allow patients to remain more than 2363
hours shall be considered a hospital for purposes of this chapter.64
(10) 'Exception acknowledgment' means a written notice from the department confirming65
that a person is exempt from the requirements of this chapter pursuant to subsection (b)66
of Code Section 31-6A-3 or pursuant to subsection (b) or (d) of Code Section 31-6A-10.67
(11) 'General cancer hospital' means an institution which was an existing and approved68
destination cancer hospital as of January 1, 2019; has obtained final certificate of need69
approval for conversion from a destination cancer hospital to a general cancer hospital70
in accordance with the former provisions of Code Section 31-6-40.3, as they existed on71
December 31, 2023; and offers inpatient and outpatient diagnostic, therapeutic, treatment,72
and rehabilitative cancer care services or other services to diagnose or treat co-morbid73
medical conditions or diseases of cancer patients so long as such services do not result74
in the offering of any new or expanded clinical health service that would require a75
certificate of need under this chapter unless a certificate of need or letter of determination76
has been obtained for such new or expanded services.77
(12) 'Health care facility' means a hospital, specialty hospital, freestanding emergency78
department not located on a hospital's primary campus, single specialty ambulatory79
surgical center, skilled nursing facility; intermediate care facility, personal care home,80
and home health agency.81
(13) 'Health maintenance organization' means a public or private organization organized82
under the laws of this state which:83
(A) Provides or otherwise makes available to enrolled participants health care services,84
including at least the following basic health care services: usual physicians' services,85
hospitalization, laboratory, X-ray, emergency and preventive services, and out-of-area86
coverage;87 23 LC 33 9433S
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(B) Is compensated, except for copayments, for the provision of the basic health care88
services listed in subparagraph (A) of this paragraph to enrolled participants on a89
predetermined periodic rate basis; and90
(C) Provides physicians' services primarily:91
(i) Directly through physicians who are either employees or partners of such92
organization; or93
(ii) Through arrangements with individual physicians organized on a group practice94
or individual practice basis.95
(14) 'Home health agency' means a public agency or private organization, or a96
subdivision of such an agency or organization, which is primarily engaged in providing97
to individuals who are under a written plan of care of a physician, on a visiting basis in98
the places of residence used as such individuals' homes, part-time or intermittent nursing99
care provided by or under the supervision of a registered professional nurse, and one or100
more of the following services:101
(A) Physical therapy;102
(B) Occupational therapy;103
(C) Speech therapy;104
(D) Medical social services under the direction of a physician; or105
(E) Part-time or intermittent services of a home health aide.106
(15) 'Hospital' means an institution which is primarily engaged in providing to inpatients,107
by or under the supervision of physicians, diagnostic services and therapeutic services for108
medical diagnosis, treatment, and care of injured, disabled, or sick persons or109
rehabilitation services for the rehabilitation of injured, disabled, or sick persons. Such110
term includes public, private, psychiatric, rehabilitative, geriatric, osteopathic,111
micro-hospitals, general cancer hospitals, and other specialty hospitals.112
(16) 'Intermediate care facility' means an institution which provides, on a regular basis,113
health related care and services to individuals who do not require the degree of care and114 23 LC 33 9433S
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treatment which a hospital or skilled nursing facility is designed to provide but who,115
because of their mental or physical condition, require health related care and services116
beyond the provision of room and board.117
(17) 'Joint venture ambulatory surgical center' means a freestanding ambulatory surgical118
center that is jointly owned by a hospital in the same county as the center or a hospital in119
a contiguous county if there is no hospital in the same county as the center and a single120
group of physicians practicing in the center and that provides surgery or where121
cardiologists perform procedures in a single specialty as defined by the department;122
provided, however, that general surgery, a group practice which includes one or more123
physiatrists who perform services that are reasonably related to the surgical procedures124
performed in the center, and a group practice in orthopedics which includes plastic hand125
surgeons with a certificate of added qualifications in Surgery of the Hand from the126
American Board of Plastic and Reconstructive Surgery shall be considered a single127
specialty. The ownership interest of the hospital shall be no less than 30 percent and the128
collective ownership of the physicians or group of physicians shall be no less than 30129
percent.130
(18) 'Life plan community' means an organization, whether operated for profit or not,131
whose owner or operator undertakes to provide shelter, food, and either nursing care or132
personal services, whether such nursing care or personal services are provided in the133
facility or in another setting, and other services, as designated by agreement, to an134
individual not related by consanguinity or affinity to such owner or operator providing135
such care pursuant to an agreement for a fixed or variable fee, or for any other136
remuneration of any type, whether fixed or variable, for the period of care, payable in a137
lump sum, lump sum and monthly maintenance charges or in installments. Agreements138
to provide continuing care include agreements to provide care for any duration, including139
agreements that are terminable by either party.140 23 LC 33 9433S
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(19) 'Micro-hospital' means a hospital in a rural county which has at least two and not141
more than seven inpatient beds and which provides emergency services seven days per142
week and 24 hours per day.143
(20) 'Multi-specialty ambulatory surgical center' means a multi-specialty physician group144
owning, operating, and utilizing no more than three specialty ambulatory surgical centers145
located in the same or different counties in which the group has provided medical146
services in a clinical office for at least five years and which limits each center to a single147
specialty which may be different single specialties; provided, however, that the specialty148
ambulatory surgical centers may be colocated.149
(21) 'Offer' means that the health care facility is open for the acceptance of patients or150
performance of services and has qualified personnel, equipment, and supplies necessary151
to provide specified clinical health services.152
(22) 'Operating room environment' means an environment which meets the minimum153
physical plant and operational standards specified in the rules of the department which154
shall consider and use the design and construction specifications as set forth in the155
Guidelines for Design and Construction of Health Care Facilities published by the156
American Institute of Architects.157
(23) 'Person' means any individual, trust or estate, partnership, limited liability company158
or partnership, corporation (including associations, joint-stock companies, and insurance159
companies), state, political subdivision, hospital authority, or instrumentality (including160
a municipal corporation) of a state as defined in the laws of this state. This term shall161
include all related parties, including individuals, business corporations, general162
partnerships, limited partnerships, limited liability companies, limited liability163
partnerships, joint ventures, nonprofit corporations, or any other for profit or not for profit164
entity that owns or controls, is owned or controlled by, or operates under common165
ownership or control with a person.166 23 LC 33 9433S
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(24) 'Personal care home' means a residential facility that is certified as a provider of167
medical assistance for Medicaid purposes pursuant to Article 7 of Chapter 4 of Title 49168
having at least 25 beds and providing, for compensation, protective care and oversight169
of ambulatory, nonrelated persons who need a monitored environment but who do not170
have injuries or disabilities which require chronic or convalescent care, including171
medical, nursing, or intermediate care. Personal care homes include those facilities172
which monitor daily residents' functioning and location, have the capability for crisis173
intervention, and provide supervision in areas of nutrition, medication, and provision of174
transient medical care. Such term does not include:175
(A) Old age residences which are devoted to independent living units with kitchen176
facilities in which residents have the option of preparing and serving some or all of their177
own meals; or178
(B) Boarding facilities which do not provide personal care.179
(25) 'Primary campus' means the building at which the majority of a hospital's or a180
remote location of a hospital's licensed and operational inpatient hospital beds are181
located, and includes the health care facilities of such hospital within 1,000 yards of such182
building. Any health care facility operated under a hospital's license prior to July 1, 2019,183
but not on the hospital's primary campus shall remain part of such hospital but shall not184
constitute such hospital's primary campus unless otherwise meeting the requirements of185
this paragraph.186
(26) 'Project' means a proposal to take an action for which a special health care services187
license is required under this chapter. A project or proposed project may refer to the188
proposal from its earliest planning stages up through the point at which the new special189
health care services are offered.190
(27) 'Remote location of a hospital' means a hospital facility or organization that is191
either created by, or acquired by, a hospital that is the main provider for the purpose of192 23 LC 33 9433S
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furnishing inpatient hospital services under the name, ownership, and financial and193
administrative control of the main provider.194
(28) 'Rural county' means a county having a population of less than 50,000 according to195
the United States decennial census of 2020 or any future such census.196
(29) 'Single specialty ambulatory surgical center' means an ambulatory surgical center197
where surgery is performed in the offices of an individual private physician or single198
group practice of private physicians if such surgery is performed in a facility that is199
owned, operated, and utilized by such physicians who also are of a single specialty;200
provided, however, that general surgery, a group practice which includes one or more201
physiatrists who perform services that are reasonably related to the surgical procedures202
performed in the center, and a group practice in orthopedics which includes plastic hand203
surgeons with a certificate of added qualifications in Surgery of the Hand from the204
American Board of Plastic and Reconstructive Surgery shall be considered a single205
specialty.206
(30) 'Skilled nursing facility' means public or private institution or a distinct part of an207
institution which is primarily engaged in providing inpatient skilled nursing care and208
related services for patients who require medical or nursing care or rehabilitation services209
for the rehabilitation of injured, disabled, or sick persons.210
(31) 'Special health care services' means any facilities or services described in211
paragraphs (1) through (4) of subsection (a) of Code Section 31-6A-3.212
(32) 'Specialty hospital' means a hospital that is primarily or exclusively engaged in the213
care and treatment of one of the following: patients with a cardiac condition, patients with214
an orthopedic condition, patients receiving a surgical procedure, or patients receiving any215
other specialized category of services defined by the department.216
(33) 'Uncompensated indigent or charity care' means the dollar amount of 'net217
uncompensated indigent or charity care after direct and indirect (all) compensation' as218 23 LC 33 9433S
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defined by, and calculated in accordance with, the department's Hospital Financial Survey219
and related instructions.220
(34) 'Urban county' means a county having a population equal to or greater than 50,000221
according to the United States decennial census of 2020 or any future such census.222
31-6A-2.223
(a) On and after January 1, 2024, no person shall operate or provide any new special health224
care services without acquiring a special health care services license under this chapter225
unless such person has an exception acknowledgment from the department.226
(b) The department shall adopt rules to specify:227
(1) The minimal requirements for quality and safety for patients receiving each special228
health care service;229
(2) The procedure for applying for and maintaining a special health care services license,230
including, but not limited to, the frequency of licensing inspections, submission of231
information, and data to evaluate the performance and ongoing operation of services and232
enforcement under this chapter;233
(3) The fees for applying for and maintaining a special health care services license in234
order to fully offset the cost to the department, including consultant fees and other related235
expenses necessary to process the application, and for any ongoing expenses to the236
department for maintaining a special health care services license; and237
(4) The procedure and criteria for requesting and approving an exception238
acknowledgment.239
31-6A-3.240
(a) A special health care services license shall be required for:241
(1) The construction of a new health care facility;242 23 LC 33 9433S
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(2) The construction of a replacement health care facility, if the bed capacity is increased243
by ten beds or 20 percent of bed capacity, whichever is greater; and244
(3) Conversion of a single specialty ambulatory surgical center to a multi-specialty245
venture ambulatory surgical center; provided the single specialty ambulatory surgical246
center demonstrates indigent and charity care services of 5 percent of revenue per year247
for the three years preceding the date of the application; and if the application for a248
conversion license is granted, the multi-specialty venture ambulatory surgical center shall249
provide indigent and charity care services totaling 2.5 percent of revenue per year and250
failure to do so shall be cause for immediate revocation of the license.251
(b) A special health care services license shall not be required for:252
(1) Adding new clinical health services;253
(2) A health care facility established on or after January 1, 2024, in a rural county, as254
defined in Code Section 31-8-9.1, that:255
(A) Provides inpatient hospital services;256
(B) Participates in both Medicaid and Medicare and accepts both Medicaid and257
Medicare patients;258
(C) Provides health care services to indigent patients;259
(D) Has at least 10 percent of its annual net revenue categorized as indigent care,260
charity care, or bad debt;261
(E) Annually files IRS Form 990, Return of Organization Exempt From Income Tax,262
with the department, or for any hospital not required to file IRS Form 990, the263
department will provide a form that collects the same information to be submitted to the264
department on an annual basis;265
(F) Is current with all audits and reports required by law; and266
(G) Has a three-year average patient margin, as a percent of expense, less than one267
standard deviation above the state-wide three-year average of organizations defined in268
subparagraphs (A) through (F) of this paragraph, as calculated by the department. For269 23 LC 33 9433S
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purposes of this subparagraph, the term 'patient margin' means gross patient revenues270
less contractual adjustments, bad debt, indigent and charity care, other uncompensated271
care, and total expenses.272
In the event that the county in which a health care facility established in accordance with273
this paragraph is located no longer meets the definition of a rural county after such health274
care facility has commenced operations, the health care facility shall be deemed to275
continue to meet the requirements of this paragraph for as long as such health care facility276
continues to operate.277
(3) Infirmaries operated by educational institutions for the sole and exclusive benefit of278
students, faculty members, officers, or employees thereof;279
(4) Infirmaries or facilities operated by businesses for the sole and exclusive benefit of280
officers or employees thereof, provided that such infirmaries or facilities make no281
provision for overnight stay by persons receiving their services;282
(5) Institutions operated exclusively by the federal government or by any of its agencies;283
(6) Offices of private physicians or dentists whether for individual or group practice;284
(7) Religious, nonmedical health care institutions as defined in 42 U.S.C.285
Section 1395x(ss)(1), listed and certified by a national accrediting organization;286
(8) Site acquisitions for health care facilities or preparation or development costs for287
such sites prior to the decision to file an application for a special health care services288
license;289
(9) Expenditures related to adequate preparation and development of an application for290
a special health care services license;291
(10) The commitment of funds conditioned upon the obtaining of a special health care292
services license;293
(11) Expenditures for the restructuring or acquisition of existing health care facilities by294
stock or asset purchase, merger, consolidation, or other lawful means;295 23 LC 33 9433S
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(12) The purchase of a closing hospital or of a hospital that has been closed for no more296
than 12 months by a hospital in a contiguous county to repurpose the facility as a297
micro-hospital;298
(13) Expenditures for the purchase, lease, replacement, upgrade, or repair of diagnostic299
imaging equipment, diagnostic or therapeutic equipment, or medical equipment or the300
provision of diagnostic imaging services;301
(14) Expenditures for nonclinical projects, including parking lots, parking decks, and302
other parking facilities; computer systems, software, and other information technology;303
medical office buildings; administrative office space; conference rooms; education304
facilities; lobbies; common spaces; clinical staff lounges and sleep areas; waiting rooms;305
bathrooms; cafeterias; hallways; engineering facilities; mechanical systems; roofs;306
grounds; signage; family meeting or lounge areas; other nonclinical physical plant307
renovations or upgrades that do not result in new or expanded clinical health services; and308
state mental health facilities;309
(15) Capital expenditures otherwise covered by this chapter required solely to eliminate310
or prevent safety hazards as defined by federal, state, or local fire, building,311
environmental, occupational health, or life safety codes or regulations, to comply with312
licensing requirements of the department, or to comply with accreditation standards of313
a nationally recognized health care accreditation body;314
(16) Cost overruns whose percentage of the cost of a project is equal to or less than the315
cumulative annual rate of increase in the composite construction index, published by the316
federal Bureau of the Census of the Department of Commerce, calculated from the date317
of approval of the project;318
(17) Transfers from one health care facility to another such facility of major medical319
equipment previously approved under or exempted from special health care services320
license review, except where such transfer results in the institution of a new clinical321 23 LC 33 9433S
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health service for which a special health care services license is required in the facility322
acquiring said equipment;323
(18) New special health care services provided by or on behalf of health maintenance324
organizations or related health care facilities in circumstances defined by the department325
pursuant to federal law;326
(19) Increases in the bed capacity of a hospital up to ten beds or 20 percent of capacity,327
whichever is greater, in any consecutive two-year period, in a hospital that has328
maintained an overall occupancy rate greater than 60 percent for the previous 12 month329
period;330
(20) Expenditures for the minor or major repair of a health care facility or a facility that331
is exempt from the requirements of this chapter or parts thereof or services provided332
therein;333
(21) Life plan communities, provided that the skilled nursing component of the facility334
is for the exclusive use of residents of the life plan community and that a written335
exemption is obtained from the department; provided, however, that new sheltered336
nursing home beds may be used on a limited basis by persons who are not residents of337
the life plan community for a period up to five years after the date of issuance of the338
initial nursing home license, but such beds shall not be eligible for Medicaid339
reimbursement. For the first year, the life plan community sheltered nursing facility may340
utilize not more than 50 percent of its licensed beds for patients who are not residents of341
the life plan community. In the second year of operation, the life plan community shall342
allow not more than 40 percent of its licensed beds for new patients who are not residents343
of the life plan community. In the third year of operation, the life plan community shall344
allow not more than 30 percent of its licensed beds for new patients who are not residents345
of the life plan community. In the fourth year of operation, the life plan community shall346
allow not more than 20 percent of its licensed beds for new patients who are not residents347
of the life plan community. In the fifth year of operation, the life plan community shall348 23 LC 33 9433S
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allow not more than 10 percent of its licensed beds for new patients who are not residents349
of the life plan community. At no time during the first five years shall the life plan350
community sheltered nursing facility occupy more than 50 percent of its licensed beds351
with patients who are not residents under contract with the life plan community. At the352
end of the five-year period, the life plan community sheltered nursing facility shall be353
utilized exclusively by residents of the life plan community, and at no time shall a354
resident of a life plan community be denied access to the sheltered nursing facility. At355
no time shall any existing patient be forced to leave the life plan community to comply356
with this paragraph. The department is authorized to promulgate rules and regulations357
regarding the use and definition of 'sheltered nursing facility' in a manner consistent with358
this Code section. Agreements to provide continuing care include agreements to provide359
care for any duration, including agreements that are terminable by either party;360
(22) Any specialty ambulatory surgical center that:361
(A) Has a hospital affiliation agreement with a hospital within a reasonable distance362
from the facility or the medical staff at the center has admitting privileges or other363
acceptable documented arrangements with such hospital to ensure the necessary backup364
for the center for medical complications. The center shall have the capability to transfer365
a patient immediately to a hospital within a reasonable distance from the facility with366
adequate emergency room services. Hospitals shall not unreasonably deny a transfer367
agreement or affiliation agreement to the center;368
(B) Provides care to Medicaid beneficiaries and, if the facility provides medical care369
and treatment to children, to PeachCare for Kids beneficiaries and provides370
uncompensated indigent and charity care in accordance with Code Section 31-6A-6;371
provided, however, that specialty ambulatory surgical centers owned by physicians in372
the practice of ophthalmology shall not be required to comply with this subparagraph;373
and374 23 LC 33 9433S
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(C) Provides annual reports in the same manner and in accordance with Code375
Section 31-6A-7.376
Noncompliance with any condition of this paragraph shall result in a monetary penalty377
in the amount of the difference between the services which the center is required to378
provide and the amount actually provided and may be subject to revocation of its379
exemption status by the department for repeated failure to pay any fines or moneys due380
to the department or for repeated failure to produce data as required by Code381
Section 31-6A-7 after notice to the exemption holder and a fair hearing pursuant to382
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.' Any penalty so383
recovered shall be dedicated and deposited by the department into the Indigent Care Trust384
Fund created pursuant to Code Section 31-8-152 for the purposes set out in Code385
Section 31-8-154, including expanding Medicaid eligibility and services; programs to386
support rural and other health care providers, primarily hospitals, who serve the medically387
indigent; and for primary health care programs for medically indigent citizens and388
children of this state;389
(23) Any joint venture ambulatory surgical center that:390
(A) Provides care to Medicaid beneficiaries and, if the facility provides medical care391
and treatment to children, to PeachCare for Kids beneficiaries and provides392
uncompensated indigent and charity care in accordance with Code Section 31-6A-6;393
and394
(B) Provides annual reports in the same manner and in accordance with Code395
Section 31-6A-7.396
Noncompliance with any condition of this paragraph shall result in a monetary penalty397
in the amount of the difference between the services which the center is required to398
provide and the amount actually provided and may be subject to revocation of its399
exemption status by the department for repeated failure to pay any fines or moneys due400
to the department or for repeated failure to produce data as required by Code401 23 LC 33 9433S
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Section 31-6A-7 after notice to the exemption holder and a fair hearing pursuant to402
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.' Any penalty so403
recovered shall be dedicated and deposited by the department into the Indigent Care Trust404
Fund created pursuant to Code Section 31-8-152 for the purposes set out in Code405
Section 31-8-154, including expanding Medicaid eligibility and services; programs to406
support rural and other health care providers, primarily hospitals, who serve the medically407
indigent; and for primary health care programs for medically indigent citizens and408
children of this state;409
(24) Diagnostic cardiac catheterization in a hospital setting on patients 15 years of age410
and older;411
(25) Therapeutic cardiac catheterization in hospitals selected by the department prior to412
July 1, 2008, to participate in the Atlantic Cardiovascular Patient Outcomes Research413
Team (C-PORT) Study and therapeutic cardiac catheterization in hospitals that, as414
determined by the department on an annual basis, meet the criteria to participate in the415
C-PORT Study but have not been selected for participation; provided, however, that if416
the criteria requires a transfer agreement to another hospital, no hospital shall417
unreasonably deny a transfer agreement to another hospital;418
(26) Infirmaries or facilities operated by, on behalf of, or under contract with the419
Department of Corrections or the Department of Juvenile Justice for the sole and420
exclusive purpose of providing health care services in a secure environment to prisoners421
within a penal institution, penitentiary, prison, detention center, or other secure422
correctional institution, including correctional institutions operated by private entities in423
this state which house inmates under the Department of Corrections or the Department424
of Juvenile Justice;425
(27) The relocation of any micro-hospital within the same county, any other health care426
facility in a rural county within the same county, and any other health care facility in an427 23 LC 33 9433S
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urban county within a three-mile radius of the existing facility so long as the facility does428
not propose to offer any new or expanded clinical health services at the new location;429
(28) Facilities which are devoted to the provision of treatment and rehabilitative care for430
periods continuing for 24 hours or longer for persons who have traumatic brain injury,431
as defined in Code Section 37-3-1;432
(29) Capital expenditures for a project otherwise requiring a special health care services433
license if those expenditures are for a project to remodel, renovate, replace, or any434
combination thereof, a medical-surgical hospital and:435
(A) That hospital:436
(i) Has a bed capacity of not more than 50 beds;437
(ii) Is located in a county in which no other medical-surgical hospital is located;438
(iii) Has at any time been designated as a disproportionate share hospital by the439
department; and440
(iv) Has at least 45 percent of its patient revenues derived from medicare, Medicaid,441
or any combination thereof, for the immediately preceding three years; and442
(B) That project:443
(i) Does not result in any of the following:444
(I) The offering of any new clinical health services;445
(II) Any increase in bed capacity;446
(III) Any redistribution of existing beds among existing clinical health services; or447
(IV) Any increase in capacity of existing clinical health services;448
(ii) Has at least 80 percent of its capital expenditures financed by the proceeds of a449
special purpose county sales and use tax imposed pursuant to Article 3 of Chapter 8450
of Title 48; and451
(iii) Is located within a three-mile radius of and within the same county as the452
hospital's existing facility;453 23 LC 33 9433S
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(30) The renovation, remodeling, refurbishment, or upgrading of a health care facility,454
so long as the project does not result in any of the following:455
(A) The offering of any new or expanded clinical health services;456
(B) Any increase in inpatient bed capacity;457
(C) Any redistribution of existing beds among existing clinical health services; or458
(D) A capital expenditure exceeding the threshold contained in paragraph (7) of Code459
Section 31-6A-1;460
(31) Other than for equipment used to provide positron emission tomography (PET)461
services, the acquisition of diagnostic, therapeutic, or other imaging equipment with a462
value of $3 million or less, by or on behalf of:463
(A) A hospital; or464
(B) An individual private physician or single group practice of physicians exclusively465
for use on patients of such private physician or single group practice of physicians and466
such private physician or member of such single group practice of physicians is467
physically present at the practice location where the diagnostic or other imaging468
equipment is located at least 75 percent of the time that the equipment is in use.469
The amount specified in this paragraph shall not include build-out costs, as defined by the470
department, but shall include all functionally related equipment, software, and any471
warranty and services contract costs for the first five years. The acquisition of one or more472
items of functionally related diagnostic or therapeutic equipment shall be considered as one473
project. The dollar amount specified in this paragraph and in paragraph (10) of this474
subsection shall be adjusted annually by an amount calculated by multiplying such dollar475
amounts (as adjusted for the preceding year) by the annual percentage of change in the476
consumer price index, or its successor or appropriate replacement index, if any, published477
by the United States Department of Labor for the preceding calendar year, commencing on478
July 1, 2010; and479
(32) A capital expenditure by a hospital at such hospital's primary campus for:480 23 LC 33 9433S
- 20 -
(A) The expansion or addition of the following clinical health services: operating481
rooms, other than dedicated outpatient operating rooms; medical-surgical services;482
gynecology; procedure rooms; intensive care; pharmaceutical services; pediatrics;483
cardiac care; or other general hospital services; provided, however, that such484
expenditure does not include the expansion or addition of inpatient beds or the485
conversion of one type of inpatient bed to another type of inpatient bed; or486
(B) The movement of clinical health services from one location on the hospital's487
primary campus to another location on such hospital's primary campus.488
31-6A-4.489
(a) An application for a special health care services license shall include:490
(1) Certification that the applicant is licensed or will seek licensure under Chapter 7 of491
this title, if subject to the requirements of such chapter;492
(2) Certification that the applicant has notified the public of the intent to file the493
application with a description of the facility or special health care services to be licensed494
by publishing a notice in a newspaper of general circulation covering the area where the495
service is to be located in at least two separate issues of the newspaper no less than ten496
business days prior to the filing of the application;497
(3) Certification that the applicant has given written notice of the intent to file the498
application by registered mail no less than ten business days prior to the filing of the499
application to the chief executive officer of each existing facility that:500
(A) Is located within a ten-mile radius of the applicant's proposed new facility or501
services;502
(B) Is the same type of facility or offers the same type of services as the proposed new503
facility or services; and504
(C) Has a special health care services license issued pursuant to this chapter; and505
(4) Any other information deemed necessary by the department.506 23 LC 33 9433S
- 21 -
(b) In addition to publication on the department's website, any application for a special507
health care services license shall be available for inspection and copying by any person508
immediately upon it being filed.509
(c) Any complete application for a special health care services license shall be approved510
by the department within 45 days of the filing of such application unless a timely objection511
in writing to such application is received by the department in accordance with512
subsection (a) of Code Section 31-6A-5.513
(d) No application for a special health care services license shall be considered if the514
applicant or any affiliate organization of the applicant has closed a health care facility515
under their ownership or reduced or ceased to provide health care services by more than516
25 percent at a facility under their or an affiliate organization's ownership within the517
previous ten years.518
31-6A-5.519
(a) A written objection to an application for a special health care services license may be520
submitted within 30 days of the filing of such application with the department, on the521
grounds that the application is not in the public interest of the community, only by an522
existing facility that:523
(1) Is located within a 35 mile radius of the applicant's proposed new facility; and524
(2) Has not closed a health care facility under their or an affiliate organization's525
ownership or reduced or ceased to provide health care services by more than 25 percent526
at a facility under their or an affiliate organization's ownership within the previous ten527
years.528
(b) No later than 30 days of receipt of a timely written objection pursuant to subsection (a)529
of this Code section, the commissioner shall conduct a public interest review and make a530
written determination as to whether the application is in the public interest of the531
community, taking into consideration any material adverse impact on the objecting party532 23 LC 33 9433S
- 22 -
or parties, unique health care needs of the community (not based on a numerical need533
formula), atypical barriers or factors, whether the new special health care services would534
foster competition or make services less costly or more accessible, and whether the535
applicant performs or proposes to perform activities outside of inpatient or outpatient care536
in the community for underserved populations. The commissioner may not deny an537
application based on an objection unless the objecting party shows by clear and convincing538
evidence that the project does not meet the criteria set forth in this subsection.539
(c) If the special health care services license is granted by the department over a timely540
objection, the person who objected shall have a right to request a fair hearing pursuant to541
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'542
(d) If the special health care services license is denied by the department after a timely543
objection, the applicant shall have a right to request a fair hearing pursuant to Chapter 13544
of Title 50, the 'Georgia Administrative Procedure Act.'545
(e) Any party to the initial administrative appeal hearing, excluding the department, may546
seek judicial review of the final decision in accordance with the method set forth in547
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'548
31-6A-6.549
(a) As a condition for special health care services licenses issued on and after550
January 1, 2024, the department shall require that an applicant or licensee agrees:551
(1) To provide uncompensated indigent or charity care in an amount which meets or552
exceeds the percentage of such applicant's adjusted gross revenues equivalent to:553
(A) The state-wide average of net uncompensated indigent and charity care provided554
based on the previous two most recent years if a nonprofit entity; or555
(B) The state-wide average of net uncompensated indigent and charity care provided556
based on the previous two most recent years less 3 percent if a for profit entity; and557 23 LC 33 9433S
- 23 -
(2) To participate as a provider of medical assistance for Medicaid purposes, and, if the558
facility provides medical care and treatment to children, to participate as a provider for559
PeachCare for Kids beneficiaries.560
(b) A grantee or successor in interest for a special health care services license or an561
authorization to operate under this chapter which violates such an agreement or violates562
any conditions imposed by the department relating to such services shall be liable to the563
department for a monetary penalty in the amount of 1 percent of its net revenue for every564
0.5 percent of uncompensated indigent and charity care not provided and may be subject565
to revocation of its special health care services license, in whole or in part, by the566
department pursuant to Code Section 31-6A-8. Any penalty so recovered shall be567
dedicated and deposited by the department into the Indigent Care Trust Fund created568
pursuant to Code Section 31-8-152 for the purposes set out in Code Section 31-8-154,569
including expanding Medicaid eligibility and services; programs to support rural and other570
health care providers, primarily hospitals, who serve the medically indigent; and for571
primary health care programs for medically indigent citizens and children of this state.572
(c) Penalties authorized under this Code section shall be subject to the same notices and573
hearing for the levy of fines under Code Section 31-6A-8.574
(d)(1) This Code section shall not apply to a hospital or any health care facilities owned575
by a hospital or health care system that has a payer mix of greater than 40 percent576
Medicaid recipients and uncompensated indigent and charity care of at least 2 percent;577
provided, however, that a hospital's cost gap between its Medicaid reimbursement rate578
and the Medicare reimbursement shall count toward such uncompensated indigent and579
charity care amount.580
(2) As used in this subsection, the term 'payer mix' means the proportionate share of581
itemized charges attributable to patients assignable to a specific payer classification to582
total itemized charges for all patients.583 23 LC 33 9433S
- 24 -
(e) The department may withhold all or any portion of disproportionate share hospital584
funds to any hospital that is subject to the requirements contained in paragraph (1) of585
subsection (a) of this Code section that fails to meet the minimum indigent and charity care586
requirements for two consecutive years.587
31-6A-7.588
(a) Each health care facility in this state that is required by the department to provide589
uncompensated indigent or charity care pursuant to Code Section 31-6A-6 shall submit an590
annual report of certain health care information to the department. The report shall be due591
on the last day of January and shall cover the 12 month period preceding each such592
calendar year.593
(b) The annual report required under subsection (a) of this Code section shall contain the594
following information:595
(1) Total gross revenues;596
(2) Bad debts;597
(3) Amounts of free care extended, excluding bad debts;598
(4) Contractual adjustments;599
(5) Amounts of care provided under a Hill-Burton commitment;600
(6) Amounts of charity care provided to indigent persons;601
(7) Amounts of outside sources of funding from governmental entities, philanthropic602
groups, or any other source, including the proportion of any such funding dedicated to the603
care of indigent persons; and604
(8) For cases involving indigent persons:605
(A) The number of persons treated;606
(B) The number of inpatients and outpatients;607
(C) Total patient days;608
(D) The number of patients categorized by county of residence; and609 23 LC 33 9433S
- 25 -
(E) The indigent care costs incurred by the health care facility by county of residence.610
As used in this subsection, the term 'indigent persons' means persons having as a maximum611
allowable income level an amount corresponding to 125 percent of the federal poverty612
guideline.613
(c) The department shall provide a form for the report required by this Code section and614
may provide in said form for further categorical divisions of the information listed in615
subsection (b) of this Code section.616
(d)(1) In the event the department does not receive an annual report from an institution,617
on or before the date such report was due or receives a timely but incomplete report, the618
department shall notify the institution regarding the deficiencies and shall be authorized619
to fine such institution an amount not to exceed $500.00 per day for every day up to 30620
days and $1,000.00 per day for every day over 30 days of such untimely or deficient621
report. Any fine so recovered shall be dedicated and deposited by the department into the622
Indigent Care Trust Fund created pursuant to Code Section 31-8-152 for the purposes set623
out in Code Section 31-8-154, including expanding Medicaid eligibility and services;624
programs to support rural and other health care providers, primarily hospitals, who serve625
the medically indigent; and for primary health care programs for medically indigent626
citizens and children of this state.627
(2) In the event the department does not receive an annual report from an institution628
within 180 days following the date such report was due or receives a timely but629
incomplete report which is not completed within such 180 days, the department shall be630
authorized to revoke such institution's permit in accordance with Code Section 31-7-4.631
31-6A-8.632
(a) The department may revoke a special health care services license, in whole or in part,633
after notice to the holder of the special health care services license and a fair hearing634 23 LC 33 9433S
- 26 -
pursuant to Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act,' for the635
following reasons:636
(1) Failure to comply with the provisions of this chapter;637
(2) The intentional provision of false information to the department by a licensee in that638
licensee's application;639
(3) Repeated failure to pay any fines or moneys due to the department;640
(4) Failure to maintain minimum quality of care standards that may be established by the641
department;642
(5) Failure to participate as a provider of medical assistance for Medicaid purposes or643
the PeachCare for Kids Program, if applicable; or644
(6) The failure to submit a timely or complete report within 180 days following the date645
the report is due pursuant to Code Section 31-6A-7.646
(b) In the event that a new special health care service is knowingly offered or developed647
without having obtained a special health care services license as required by this chapter,648
or the special health care services license for such service is revoked according to the649
provisions of this Code section, a facility or applicant may be fined an amount of $5,000.00650
per day up to 30 days, $10,000.00 per day from 31 days through 60 days, and $25,000.00651
per day after 60 days for each day that the violation of this chapter has existed and652
knowingly and willingly continues; provided, however, that the expenditure or653
commitment of or incurring an obligation for the expenditure of funds to take or perform654
actions not subject to this chapter or to acquire, develop, or prepare a health care facility655
site for which a special health care services license application is denied shall not be a656
violation of this chapter and shall not be subject to such a fine. The commissioner shall657
determine, after notice and a hearing, whether the fines provided in this Code section shall658
be levied. Any fine so recovered shall be dedicated and deposited by the department into659
the Indigent Care Trust Fund created pursuant to Code Section 31-8-152 for the purposes660
set out in Code Section 31-8-154, including expanding Medicaid eligibility and services;661 23 LC 33 9433S
- 27 -
programs to support rural and other health care providers, primarily hospitals, who serve662
the medically indigent; and for primary health care programs for medically indigent663
citizens and children of this state.664
(c) In addition, for purposes of this Code section, the State of Georgia, acting by and665
through the department, or any other interested person, shall have standing in any court of666
competent jurisdiction to maintain an action for injunctive relief to enforce the provisions667
of this chapter.668
(d) The department shall have the authority to make public or private investigations or669
examinations inside or outside of this state to determine whether any provisions of this670
chapter or any other law, rule, regulation, or formal order relating to the provision of671
special health care services has been violated. Such investigations may be initiated at any672
time in the discretion of the department and may continue during the pendency of any673
action initiated by the department pursuant to this Code section. For the purpose of674
conducting any investigation or inspection pursuant to this subsection, the department shall675
have the authority, upon providing reasonable notice, to require the production of any676
books, records, papers, or other information related to any special health care services677
license issue.678
31-6A-9.679
Any person who acquires a health care facility by stock or asset purchase, merger,680
consolidation, or other lawful means shall notify the department of such acquisition, the681
date thereof, and the name and address of the acquiring person. Such notification shall be682
made in writing to the department within 45 days following the acquisition and the683
acquiring person may be fined by the department in the amount of $500.00 for each day684
that such notification is late. Such fine shall be paid into the state treasury. Any fine so685
recovered shall be dedicated and deposited by the department into the Indigent Care Trust686
Fund created pursuant to Code Section 31-8-152 for the purposes set out in Code687 23 LC 33 9433S
- 28 -
Section 31-8-154, including expanding Medicaid eligibility and services; programs to688
support rural and other health care providers, primarily hospitals, who serve the medically689
indigent; and for primary health care programs for medically indigent citizens and children690
of this state.691
31-6A-10.692
(a) Except as provided in subsection (c) of this Code section, on and after January 1, 2024,693
health care facilities, as defined in Code Section 31-6A-1, shall not be subject to the former694
provisions of Chapter 6 of this title, as such existed on December 31, 2023, and shall not695
be required to obtain or retain a certificate of need in order to operate, but all such valid696
certificates of need in existence on December 31, 2023, shall be converted by operation of697
law to special health care services licenses and all such license holders shall be subject to698
the provisions of this chapter on and after such date; provided, however, that such health699
care facilities shall not be subject to the requirements of Code Section 31-6A-6 but shall700
instead be subject to any conditions previously imposed by the department relating to701
indigent or charity care and participation as a Medicaid provider that were in effect on702
December 31, 2023, pursuant to the former provisions of Chapter 6 of this title, as such703
existed on December 31, 2023. The department may withhold all or any portion of704
disproportionate share hospital funds to any hospital exempt pursuant to this subsection705
that fails to meet any conditions previously imposed by the department relating to indigent706
and charity care for two consecutive years. In the event a health care facility operating707
pursuant to this subsection receives any modification of its special health care services708
license, it shall immediately become subject to the requirements contained in Code Section709
31-6A-6 in lieu of the conditions previously imposed by the department relating to indigent710
or charity care and participation as a Medicaid provider or PeachCare for Kids Program711
provider that were in effect on December 31, 2023.712 23 LC 33 9433S
- 29 -
(b)(1) On and after January 1, 2024, any person who had a valid exemption from713
certificate of need requirements under the former provisions of Chapter 6 of this title, as714
such existed on December 31, 2023, shall not be required to obtain or retain a special715
health care services license under this chapter in order to operate, but any such valid716
exemption in existence on December 31, 2023, shall be converted by operation of law to717
an exemption to special health care services license requirements under this chapter but718
shall be subject to any conditions previously imposed pursuant to the former provisions719
of Chapter 6 of this title, as such existed on December 31, 2023.720
(2) In the event a person that is exempt pursuant to paragraph (1) of this subsection721
makes any modification to the special health care services it provides, it shall722
immediately become subject to the requirements contained in Code Section 31-6A-6 in723
lieu of the conditions previously imposed by the department relating to indigent or charity724
care and participation as a Medicaid provider or PeachCare for Kids Program provider725
that were in effect on December 31, 2023.726
(c)(1) On and after January 1, 2024, a destination cancer hospital that was granted a727
certificate of need pursuant to the former provisions of Chapter 6 of this title, as such728
existed on December 31, 2023, may convert to a hospital by notifying the department in729
writing as to the date of conversion. Upon such conversion, the hospital may continue730
to provide all institutional health services and other services it provided as of the date of731
such conversion, including, but not limited to, inpatient beds, outpatient services, surgery,732
radiation therapy, imaging, and positron emission tomography (PET) scanning, without733
any further approval from the department; provided, however, that upon such conversion,734
such hospital shall immediately become subject to the requirements of Code735
Section 31-6A-6. On and after the date of conversion, the hospital shall be classified as736
a hospital under this chapter and shall be subject to all requirements and conditions for737
any new special health care services license requirements, exemptions, and for all other738
purposes, except as otherwise provided herein.739 23 LC 33 9433S
- 30 -
(2) In the event that a destination cancer hospital does not convert to a hospital, it shall740
remain subject to all requirements and conditions previously in effect as of741
December 31, 2023, under the provisions of Chapter 6 of this title as they existed on such742
date.743
(d) Any outstanding appeals before the Certificate of Need Appeal Panel as of744
December 31, 2023, relating to health care facilities, as defined in Code Section 31-6A-1,745
shall be deemed moot and dismissed by operation of law as of January 1, 2024.746
31-6A-11.747
The department shall be authorized to promulgate rules and regulations to implement the748
provisions of this chapter."749
PART III750
SECTION 3-1.751
Said title is further amended in Article 2 of Chapter 7, relating to the Georgia Building752
Authority, by redesignating Code Section 31-7-24 as Code Section 31-7-25 and by adding753
a new Code section to the end of Article 1, relating to regulation of hospitals and related754
institutions, to read as follows:755
"31-7-24.756
(a) As used in this Code section, the term:757
(1) 'Hospital' shall have the same meaning as in Code Section 31-7-22.758
(2) 'Medical use rights' means rights or interests in real property in which the owner of759
the property has agreed not to sell or lease such real property for identified medical uses760
or purposes.761
(b) It shall be unlawful for any hospital to purchase, renew, extend, lease, maintain, or hold762
medical use rights.763 23 LC 33 9433S
- 31 -
(c) This Code section shall not be construed to impair any contracts in existence as of the764
effective date of this Code section."765
SECTION 3-2.766
Code Section 50-18-70 of the Official Code of Georgia Annotated, relating to legislative767
intent and definitions relative to open records laws, is amended by revising subsection (b)768
as follows:769
"(b) As used in this article, the term:770
(1) 'Agency' shall have the same meaning as in Code Section 50-14-1 and shall771
additionally include any association, corporation, or other similar organization that has772
a membership or ownership body composed primarily of counties, municipal773
corporations, or school districts of this state, their officers, or any combination thereof774
and derives more than 33 1/3 percent of its general operating budget from payments from775
such political subdivisions. Such term shall also include any nonprofit organization to776
which is leased and transferred hospital assets of a hospital authority through a corporate777
restructuring and any subsidiaries or foundations established by such nonprofit778
organization in furtherance of the public mission of the hospital authority.779
(2) 'Public record' means all documents, papers, letters, maps, books, tapes, photographs,780
computer based or generated information, data, data fields, or similar material prepared781
and maintained or received by an agency or by a private person or entity in the782
performance of a service or function for or on behalf of an agency or when such783
documents have been transferred to a private person or entity by an agency for storage784
or future governmental use, including, but not limited to, any such material in the785
possession or control of a nonprofit organization to which is leased and transferred786
hospital assets of a hospital authority through a corporate restructuring which are related787
to the operation of the hospital and other leased facilities in the performance of services788
on behalf of the hospital authority."789 23 LC 33 9433S
- 32 -
PART IV790
SECTION 4-1.791
Code Section 16-11-62 of the Official Code of Georgia Annotated, relating to eavesdropping,792
surveillance, or intercepting communication which invades privacy of another, and divulging793
private message, is amended by revising paragraph (8) as follows:794
"(8) Any person to intentionally and in a clandestine manner place, or direct someone795
else to place, a global positioning system monitoring device, or any other electronic796
monitoring device, on a motor vehicle owned or leased by another person without the797
consent of such person when such person has a protective order pursuant to Code Section798
17-17-16, 19-13-4, or 19-13A-4, or a protective order from another jurisdiction, against799
the person who places, or directs another to place, the global positioning system800
monitoring device or other electronic device. Nothing in this paragraph shall be801
construed to limit electronic monitoring as provided in Code Sections 31-7-12 and802
31-7-12.1, and 31-6-2; or"803
SECTION 4-2.804
Title 31 of the Official Code of Georgia Annotated, relating to health, is amended in Code805
Section 31-2-4, relating to the powers, duties, functions, and responsibilities of the806
Department of Community Health, by revising paragraph (13) of subsection (d) as follows:807
"(13) Shall request any necessary federal approval for and facilitate the application of808
certificates of need for facilities capable of providing long-term care services, with809
Medicaid as the primary funding source, to inmates who are eligible for such services and810
funding upon his or her their release from a public institution, as such term is defined in811
Code Section 49-4-31."812 23 LC 33 9433S
- 33 -
SECTION 4-3.813
Said title is further amended in Code Section 31-2-5, relating to the transfer of personnel and814
functions to the Department of Community Health, by revising subsection (c) as follows:815
"(c) The department shall succeed to all rules, regulations, policies, procedures, and816
administrative orders of the predecessor agency or unit which were in effect on June 30,817
2009, or scheduled to go into effect on or after July 1, 2009, and which relate to the818
functions transferred to the department by this chapter. Such rules, regulations, policies,819
procedures, and administrative orders shall remain in effect until amended, repealed,820
superseded, or nullified by proper authority or as otherwise provided by law. Rules of the821
department shall be adopted, promulgated, and implemented as provided in Chapter 13 of822
Title 50, the 'Georgia Administrative Procedure Act,.' except that only rules promulgated823
pursuant to Chapter 6 of this title shall be subject to the provisions of Code Section824
31-6-21.1."825
SECTION 4-4.826
Said title is further amended in Code Section 31-2-7, relating to rules and regulations and827
variances and waivers, by revising subsection (b) as follows:828
"(b) The department upon application or petition may grant variances and waivers to829
specific rules and regulations which establish standards for facilities or entities regulated830
by the department as follows:831
(1) The department may authorize departure from the literal requirements of a rule or832
regulation by granting a variance upon a showing by the applicant or petitioner that the833
particular rule or regulation that is the subject of the variance request should not be834
applied as written because strict application would cause undue hardship. The applicant835
or petitioner additionally must show that adequate standards affording protection of836
health, safety, and care exist and will be met in lieu of the exact requirements of the rule837
or regulation in question;838 23 LC 33 9433S
- 34 -
(2) The department may dispense entirely with the enforcement of a rule or regulation839
by granting a waiver upon a showing by the applicant or petitioner that the purpose of the840
rule or regulation is met through equivalent standards affording equivalent protection of841
health, safety, and care;842
(3) The department may grant waivers and variances to allow experimentation and843
demonstration of new and innovative approaches to delivery of services upon a showing844
by the applicant or petitioner that the intended protections afforded by the rule or845
regulation which is the subject of the request are met and that the innovative approach has846
the potential to improve service delivery;847
(4) Waivers or variances which affect an entire class of facilities may only be approved848
by the Board of Community Health and shall be for a time certain, as determined by the849
board. A notice of the proposed variance or waiver affecting an entire class of facilities850
shall be made in accordance with the requirements for notice of rule making in Chapter851
13 of Title 50, the 'Georgia Administrative Procedure Act'; or852
(5) Variances or waivers which affect only one facility in a class may be approved or853
denied by the department and shall be for a time certain, as determined by the854
department. The department shall maintain a record of such action and shall make this855
information available to the board and all other persons who request it.856
This subsection shall not apply to rules adopted by the department pursuant to Code857
Section 31-6-21.1."858
SECTION 4-5.859
Said title is further amended in Code Section 31-7-3, relating to requirements for permits to860
operate institutions, by revising subsection (a) as follows:861
"(a) Any person or persons responsible for the operation of any institution, or who may862
hereafter propose to establish and operate an institution and to provide specified clinical863
services, shall submit an application to the department for a permit to operate the institution864 23 LC 33 9433S
- 35 -
and provide such services, with such application to be made on forms prescribed by the865
department. No institution shall be operated in this state without such a permit, which shall866
be displayed in a conspicuous place on the premises. No clinical services shall be provided867
by an institution except as approved by the department in accordance with the rules and868
regulations established pursuant to Code Section 31-7-2.1. Failure or refusal to file an869
application for a permit shall constitute a violation of this chapter and shall be dealt with870
as provided for in Article 1 of Chapter 5 of this title. Following inspection and871
classification of the institution for which a permit is applied for, the department may issue872
or refuse to issue a permit or a provisional permit. Permits issued shall remain in force and873
effect until revoked or suspended; provisional permits issued shall remain in force and874
effect for such limited period of time as may be specified by the department. Upon875
conclusion of the Atlantic Cardiovascular Patient Outcomes Research Team (C-PORT)876
Study, the department shall consider and analyze the data and conclusions of the study and877
promulgate rules pursuant to Code Section 31-7-2.1 to regulate the quality of care for878
therapeutic cardiac catheterization. All hospitals that participated in the study and are were879
exempt from obtaining a certificate of need based on paragraph (22) of subsection (a) of880
former Code Section 31-6-47 as it existed on December 31, 2023, shall apply for a permit881
to continue providing therapeutic cardiac catheterization services once the department882
promulgates the rules required by this Code section."883
SECTION 4-6.884
Said title is further amended in Code Section 31-7-75, relating to the functions and powers885
of county and municipal hospital authorities, by revising paragraph (24) as follows:886
"(24) To provide management, consulting, and operating services including, but not887
limited to, administrative, operational, personnel, and maintenance services to another888
hospital authority, hospital, health care facility, as said term is defined in Chapter 6 of this889
title Code Section 31-6A-1, person, firm, corporation, or any other entity or any group890 23 LC 33 9433S
- 36 -
or groups of the foregoing; to enter into contracts alone or in conjunction with others to891
provide such services without regard to the location of the parties to such transactions;892
to receive management, consulting, and operating services including, but not limited to,893
administrative, operational, personnel, and maintenance services from another such894
hospital authority, hospital, health care facility, person, firm, corporation, or any other895
entity or any group or groups of the foregoing; and to enter into contracts alone or in896
conjunction with others to receive such services without regard to the location of the897
parties to such transactions;"898
SECTION 4-7.899
Said title is further amended in Code Section 31-7-94.1, the "Rural Hospital Organization900
Assistance Act," by revising paragraph (1) of subsection (e) as follows:901
"(1) Infrastructure development, including, without being limited to, health information902
technology, facility renovation, or equipment acquisition; provided, however, that the903
amount granted to any qualified hospital may not exceed the expenditure thresholds that904
would constitute a new institutional health service requiring a certificate of need under905
Chapter 6 of this title and the grant award may be conditioned upon obtaining local906
matching funds;"907
SECTION 4-8.908
Said title is further amended in Code Section 31-7-116, relating to provisions contained in909
obligations and security for obligations, procedures for issuance of bonds and bond910
anticipation notes, interest rates, and limitations and conditions, by revising subsection (i)911
as follows:912
"(i) No bonds or bond anticipation notes except refunding bonds shall be issued by an913
authority under this article unless its board of directors shall adopt adopts a resolution914
finding that the project for which such bonds or notes are to be issued will promote the915 23 LC 33 9433S
- 37 -
objectives stated in subsection (b) of Code Section 31-7-111 and will increase or maintain916
employment in the territorial area of such authority. Nothing contained in this Code917
section shall be construed as permitting any authority created under this article or any918
qualified sponsor to finance, construct, or operate any project without obtaining any919
certificate of need or other approval, permit, or license which, under the laws of this state,920
is required in connection therewith."921
SECTION 4-9.922
Said title is further amended by repealing and reserving Code Section 31-7-155, relating to923
certificates of need for new service or extending service area and exemption from certificate.924
SECTION 4-10.925
Said title is further amended by repealing in its entirety Code Section 31-7-179, relating to926
certificate of need not required for hospice care.927
SECTION 4-11.928
Said title is further amended by revising Code Section 31-7-307, relating to certificate of929
need not required of private home care provider licensees, as follows:930
"31-7-307.931
(a) A certificate of need issued pursuant to Chapter 6 of this title is not required for any932
person, business entity, corporation, or association, whether operated for profit or not for933
profit, which is operating as a private home care provider as long as such operation does934
not also constitute such person, entity, or organization operating as a home health agency935
or personal care home under this chapter.936
(b) A license issued under this article shall not entitle the licensee to operate as a home937
health agency, as defined in Code Section 31-7-150, under medicare Medicare or Medicaid938
guidelines."939 23 LC 33 9433S
- 38 -
SECTION 4-12.940
Said title is further amended by revising Code Section 31-8-153.1, relating to irrevocable941
transfer of funds to trust fund and provision for indigent patients, as follows:942
"31-8-153.1.943
After June 30, 1993, any hospital authority, county, municipality, or other state or local944
public or governmental entity is authorized to transfer moneys to the trust fund. Transfer945
of funds under the control of a hospital authority, county, municipality, or other state or946
local public or governmental entity shall be a valid public purpose for which those funds947
may be expended. The department is authorized to transfer to the trust fund moneys paid948
to the state by a health care facility as a monetary penalty for the violation of an agreement949
to provide a specified amount of clinical health services to indigent patients uncompensated950
indigent or charity care pursuant to a certificate of need license held by such facility. Such951
transfers shall be irrevocable and shall be used only for the purposes contained in Code952
Section 31-8-154."953
SECTION 4-13.954
Said title is further amended by revising Code Section 31-8-181, relating to individuals and955
hospitals excluded from application of article, as follows:956
"31-8-181.957
This article shall not apply to the following:958
(1) An individual licensed to practice medicine under the provisions of Chapter 34 of959
Title 43, and persons employed by such an individual, provided that any nursing home,960
personal care home as defined by Code Section 31-6-2 31-6A-1, hospice as defined by961
Code Section 31-7-172, respite care service as defined by Code Section 49-6-72, adult962
day program, or home health agency owned, operated, managed, or controlled by a963
person licensed to practice medicine under the provisions of Chapter 34 of Title 43 shall964
be subject to the provisions of this article; or965 23 LC 33 9433S
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(2) A hospital. However, to the extent that a hospital's nursing home, personal care966
home as defined by Code Section 31-6-2 31-6A-1, hospice as defined by Code Section967
31-7-172, respite care service as defined by Code Section 49-6-72, adult day program,968
or home health agency holds itself out as providing care, treatment, or therapeutic969
activities for persons with Alzheimer's disease or Alzheimer's related dementia as part of970
a specialty unit, such nursing home, personal care home, hospice, respite care service,971
adult day program, or home health agency shall be subject to the provisions of this972
article."973
SECTION 4-14.974
Said title is further amended in Code Section 31-11-100, relating to definitions relative to the975
Georgia Trauma Care Network Commission, by revising paragraph (3) as follows:976
"(3) 'Trauma center' means a facility designated by the Department of Public Health as977
a Level I, II, III, or IV or burn trauma center. However, a burn trauma center shall not978
be considered or treated as a trauma center for purposes of certificate of need979
requirements under state law or regulations, including exceptions to need and adverse980
impact standards allowed by the department for trauma centers or for purposes of981
identifying safety net hospitals."982
SECTION 4-15.983
Code Section 33-45-1 of the Official Code of Georgia Annotated, relating to definitions984
relative to continuing care providers and facilities, is amended by revising paragraphs (1),985
(8), and (15) as follows:986
"(1) 'Continuing care' means furnishing pursuant to a continuing care agreement:987
(A) Lodging that is not:988
(i) In a skilled nursing facility, as such term is defined in Code Section 31-6-2 Code989
Section 31-6A-1;990 23 LC 33 9433S
- 40 -
(ii) An intermediate care facility, as such term is defined in Code Section 31-6-2991
Code Section 31-6A-1;992
(iii) An assisted living community, as such term is defined in Code Section993
31-7-12.2; or994
(iv) A personal care home, as such term is defined in Code Section 31-7-12;995
(B) Food; and996
(C) Nursing care provided in a facility or in another setting designated by the997
agreement for continuing care to an individual not related by consanguinity or affinity998
to the provider furnishing such care upon payment of an entrance fee including skilled999
or intermediate nursing services and, at the discretion of the continuing care provider,1000
personal care services including, without limitation, assisted living care services1001
designated by the continuing care agreement, including such services being provided1002
pursuant to a contract to ensure the availability of such services to an individual not1003
related by consanguinity or affinity to the provider furnishing such care upon payment1004
of an entrance fee.1005
Such term shall not include continuing care at home."1006
"(8) 'Limited continuing care' means furnishing pursuant to a continuing care agreement:1007
(A) Lodging that is not:1008
(i) In a skilled nursing facility, as such term is defined in Code Section 31-6-2 Code1009
Section 31-6A-1;1010
(ii) An intermediate care facility, as such term is defined in Code Section 31-6-21011
Code Section 31-6A-1;1012
(iii) An assisted living community, as such term is defined in Code Section1013
31-7-12.2; or1014
(iv) A personal care home, as such term is defined in Code Section 31-7-12;1015
(B) Food; and1016 23 LC 33 9433S
- 41 -
(C) Personal services, whether such personal services are provided in a facility such1017
as a personal care home or an assisted living community or in another setting1018
designated by the continuing care agreement, to an individual not related by1019
consanguinity or affinity to the provider furnishing such care upon payment of an1020
entrance fee.1021
Such term shall not include continuing care at home."1022
"(15) 'Residential unit' means a residence or apartment in which a resident lives that is1023
not a skilled nursing facility as defined in Code Section 31-6-2 Code Section 31-6A-1,1024
an intermediate care facility as defined in Code Section 31-6-2 Code Section 31-6A-1,1025
an assisted living community as defined in Code Section 31-7-12.2, or a personal care1026
home as defined in Code Section 31-7-12."1027
SECTION 4-16.1028
Code Section 33-45-3 of the Official Code of Georgia Annotated, relating to certificate of1029
authority required for operation of life plan facilities, is amended by revising subsections (b)1030
and (d) as follows:1031
"(b) Nothing in this chapter shall be construed so as to modify or limit in any way:1032
(1) Provisions of Article 3 of Chapter 6 of Title 31 and any rules and regulations1033
promulgated by the Department of Community Health pursuant to such article relating1034
to certificates of need for life plan communities or home health agencies, as such terms1035
are defined in Code Section 31-6-2; or1036
(2) Provisions provisions of Chapter 7 of Title 31 relating to licensure or permit1037
requirements and any rules and regulations promulgated by the Department of1038
Community Health pursuant to such chapter, including, without limitation, licensure or1039
permit requirements for nursing home care, assisted living care, personal care home1040
services, home health services, and private home care services."1041 23 LC 33 9433S
- 42 -
"(d) A provider of continuing care at home may contract with a licensed home health1042
agency to provide home health services to a resident. In order to provide home health1043
services directly, a provider of continuing care at home shall obtain a certificate of need for1044
a home health agency, as such term is defined in Code Section 31-6-2 31-6A-1, pursuant1045
to the same criteria and rules as are applicable to freestanding home health agencies that1046
are not components of life plan communities."1047
SECTION 4-17.1048
Code Section 33-45-7.1 of the Official Code of Georgia Annotated, relating to provider1049
authorized to offer continuing care when resident purchases resident owned living unit, is1050
amended as follows:1051
"33-45-7.1.1052
A provider which has obtained a certificate of authority pursuant to Code Section 33-45-51053
and the written approval of the Commissioner is authorized to offer, as a part of the1054
continuing care agreement, continuing care at home or continuing care in which the1055
resident purchases a resident owned living unit, subject to the provisions of Chapters 6 6A1056
and 7 of Title 31 and rules and regulations promulgated by the Department of Community1057
Health pursuant to such chapters chapter relating to certificate of need and licensure1058
requirements."1059
SECTION 4-18.1060
Code Section 37-1-29 of the Official Code of Georgia Annotated, relating to crisis1061
stabilization units, is amended by revising subsection (j) as follows:1062
"(j) Any program certified as a crisis stabilization unit pursuant to this Code section shall1063
be exempt from the requirements to obtain a certificate of need pursuant to Article 3 of1064
Chapter 6 of Title 31. Reserved."1065 23 LC 33 9433S
- 43 -
SECTION 4-19.1066
Code Section 43-26-7 of the Official Code of Georgia Annotated, relating to requirements1067
for licensure as a registered professional nurse, is amended by revising paragraph (4) of1068
subsection (c) as follows:1069
"(4)(A)(i) Meet continuing competency requirements as established by the board;1070
(B)(ii) If the applicant entered a nontraditional nursing education program as a1071
licensed practical nurse whose academic education as a licensed practical nurse1072
included clinical training in pediatrics, obstetrics and gynecology, medical-surgical,1073
and mental illness, have has practiced nursing as a registered professional nurse in a1074
health care facility for at least one year in the three years preceding the date of the1075
application, and such practice is documented by the applicant and approved by the1076
board; provided, however, that for an applicant who does not meet the experience1077
requirement of this subparagraph division, the board shall require the applicant to1078
complete a 320 hour postgraduate preceptorship arranged by the applicant under the1079
oversight of a registered nurse where such applicant is transitioned into the role of a1080
registered professional nurse. The preceptorship shall have prior approval of the1081
board, and successful completion of the preceptorship shall be verified in writing by1082
the preceptor; or1083
(C)(iii) If the applicant entered a nontraditional nursing education program as1084
anything other than a licensed practical nurse whose academic education as a licensed1085
practical nurse included clinical training in pediatrics, obstetrics and gynecology,1086
medical-surgical, and mental illness, have has graduated from such program and1087
practiced nursing as a registered professional nurse in a health care facility for at least1088
two years in the five years preceding the date of the application, and such practice is1089
documented by the applicant and approved by the board; provided, however, that for1090
an applicant who does not meet the experience requirement of this subparagraph1091
division, the board shall require the applicant to complete a postgraduate1092
preceptorship of at least 480 hours but not more than 640 hours, as determined by the1093 23 LC 33 9433S
- 44 -
board, arranged by the applicant under the oversight of a registered professional nurse1094
where such applicant is transitioned into the role of a registered professional nurse.1095
The preceptorship shall have prior approval of the board, and successful completion1096
of the preceptorship shall be verified in writing by the preceptor.1097
(B) For purposes of this paragraph, the term 'health care facility' means an acute care1098
inpatient facility, a long-term acute care facility, an ambulatory surgical center or1099
obstetrical facility as defined in Code Section 31-6-2 31-6A-1, and a skilled nursing1100
facility, so long as such skilled nursing facility has 100 beds or more and provides1101
health care to patients with similar health care needs as those patients in a long-term1102
acute care facility;"1103
SECTION 4-20.1104
Code Section 50-13-42 of the Official Code of Georgia Annotated, relating to the1105
applicability of the Administrative Procedure Act, is amended by revising subsection (a) as1106
follows:1107
"(a) In addition to those agencies expressly exempted from the operation of this chapter1108
under paragraph (1) of Code Section 50-13-2, this article shall not apply to the1109
Commissioner of Agriculture, the Public Service Commission, the Certificate of Need1110
Appeal Panel, or the Department of Community Health, unless specifically provided1111
otherwise for certain programs or in relation to specific laws, or to the Department of Labor1112
with respect to unemployment insurance benefit hearings conducted under the authority of1113
Chapter 8 of Title 34. Such exclusion does not prohibit such office or agencies from1114
contracting with the Office of State Administrative Hearings on a case-by-case basis."1115
SECTION 4-21.1116
Code Section 50-26-19 of the Official Code of Georgia Annotated, relating to financing1117
acquisition, construction, and equipping of health care facilities, is amended by repealing1118
subsection (c).1119 23 LC 33 9433S
- 45 -
SECTION 4-22.1120
Code Section 51-16-1 of the Official Code of Georgia Annotated, relating to definitions1121
relative to the COVID-19 Pandemic Business Safety Act, is amended by revising paragraph1122
(5) as follows:1123
"(5) 'Healthcare facility' shall have the same meaning as 'healthcare facility' as provided1124
for in paragraph (17) of Code Section 31-6-2, as it existed on December 30, 2023, and1125
all related parties; as 'institution' as provided for in subparagraphs (A) and (C) through1126
(G) of paragraph (4) and paragraph (5) of Code Section 31-7-1 and all related parties; as1127
'end stage renal disease' as provided for in paragraph (6) of Code Section 31-44-1 and all1128
related parties; and shall mean the recipient of a contract as authorized in paragraph (5)1129
of Code Section 37-1-20 and any clinical laboratory certified under the Clinical1130
Laboratory Improvement Amendments in Section 353 of the Public Health Service Act,1131
42 U.S.C. Section 263a. Such term shall not be construed to include premises."1132
PART V1133
SECTION 5-1.1134
For purposes of rule-making, this Act shall become effective upon its approval by the1135
Governor or upon its becoming law without such approval. For all other purposes, this Act1136
shall become effective on January 1, 2024.1137
SECTION 5-2.1138
All laws and parts of laws in conflict with this Act are repealed.1139