Ga. Comp. R. & Regs. R. 111-2-2-.03 - Exemptions from Review
The following shall not be subject to Certificate of Need review and shall be exempted from the provisions of these Rules regarding Certificate of Need Review except as otherwise provided:
(1) infirmaries operated by educational
institutions for the sole and exclusive benefit of students, faculty members,
officers, or employees thereof;
(2)
infirmaries or facilities operated by businesses for the sole and exclusive
benefit of officers or employees thereof, provided that such infirmaries or
facilities make no provision for overnight stay by persons receiving their
services;
(3) institutions operated
exclusively by the federal government or by any of its agencies;
(4) offices of private physicians or
dentists, as determined in the sole discretion of the Department, whether for
individual or group practice except as otherwise provided in Ga. Comp. R. &
Regs. r. 111-2-2-.01(54) and
Ga. Comp. R. & Regs. r.
111-2-2-.01(42)(f).
Simple ownership of a facility by a practitioner or a group of practitioners of
the healing arts does not, in and of itself, exempt such facility from the
scope of these Rules. Seeking licensure of a place, building, or facility as a
health care institution is inconsistent with an assertion that such place,
building, or facility is being occupied exclusively as the office of private
physicians or dentists. Therefore, any person who seeks licensure as a health
care facility must secure a Certificate of Need if a new institutional health
service is being offered or developed;
(5) Religious, nonmedical health care
institutions as defined in 42 U.S.C. Section
1395x(ss)(1), listed and
certified by a national accrediting organization;
(6) site acquisitions for health care
facilities or preparation or development costs for such sites prior to filing a
Certificate of Need application;
(7) expenditures related to adequate
preparation and development of an application for a Certificate of
Need;
(8) the commitment of funds
conditioned upon the obtaining of a Certificate of Need;
(9) transfers from one health care facility
to another such facility of major medical equipment previously approved under
or exempted from Certificate of Need review, except where such transfer results
in the institution of a new clinical health service for which a Certificate of
Need is required in the facility acquiring said equipment, provided that such
transfers are recorded at net book value of the medical equipment as recorded
on the books of the transferring facility;
(10) expenditures for the restructuring or
acquisition of existing health care facilities by stock or asset purchase,
merger, consolidation, or other lawful means;
(11) the purchase of a closing hospital or of
a hospital that has been closed for no more than twelve (12) months by a
hospital in a contiguous county to repurpose the facility as a
micro-hospital;
(12) capital
expenditures otherwise covered by this Chapter required solely to eliminate or
prevent safety hazards as defined by federal, state or local fire, building,
environmental occupational health, or life safety codes of regulations, to
comply with licensing requirements of the Healthcare Facility Regulation
Division, or to comply with accreditation standards of the Joint Commission or
another nationally recognized health care accreditation body;
(13) all cost overruns are excluded from
prior Certificate of Need review and approval;
(14) increases in the bed capacity of a
hospital up to ten beds or twenty percent (20%) of capacity, whichever is
greater, in any consecutive three-year period, in a hospital that has
maintained an overall occupancy rate greater than sixty percent (60%)
(exclusive of any skilled nursing units or comprehensive inpatient
rehabilitation units) for the previous twelve (12) month period;
(15) The acquisition, replacement, or repair
of diagnostic therapeutic, or other imaging equipment by any health care
facility in existence prior to July 1, 2024, that is not owned by a group
practice of physicians or a hospital and that provides diagnostic imaging
services so long as it does not result in the offering of any new clinical
health services;
(16) An
expenditures for the minor or major repair of a health care facility or a
facility that is exempt from the requirements of these Rules, parts thereof or
services provided therein;
(17) new
institutional health services offered by or on behalf of a Health Maintenance
Organization, or a health facility controlled, directly or indirectly, by a
Health Maintenance Organization or a combination of Health Maintenance
Organizations, provided specific and detailed documentation is provided to the
Department that one of the following conditions are met:
(a) that seventy-five percent (75%) of the
patients who can reasonably be expected to use the service will be individuals
enrolled in a Health Maintenance Organization certified by the State of
Georgia;
(b) that the service is
needed by the Health Maintenance Organization in order to operate efficiently
and economically and that it is not otherwise readily accessible to the Health
Maintenance Organization because:
1. existing
similar services are not available under a contract of reasonable
duration;
2. full and equal staff
privileges are not available in existing facilities; or
3. arrangements with existing facilities are
not administratively feasible;
(18) capital expenditures for a project
otherwise requiring a Certificate of Need if those expenditures are for a
project to remodel, renovate, replace, or any combination thereof, a
medical-surgical hospital and all the following conditions are met:
(a) the hospital has a bed capacity of not
more than fifty (50) beds;
(b) the
hospital is located in a county in which no other medical-surgical hospital is
located;
(c) the hospital has at
any time been designated as a disproportionate share hospital by the
Department;
(d) the hospital has at
least forty-five percent (45%) of its patient revenues derived from Medicare,
Medicaid, or any combination thereof, for the immediately preceding three
years;
(e) the project has at least
eighty percent (80%) of its capital expenditures financed by proceeds of a
special purpose county sales and use tax imposed pursuant to Article 3 of
Chapter 8 of Title 48;
(f) the
proposed replacement hospital is located within a five (5)-mile radius of and
within the same county as the hospital's existing facility; and
(g) the project does not result in any of the
following:
1. the offering of any new clinical
health services;
2. any increase in
bed capacity;
3. any redistribution
of existing beds among existing clinical health services; and
4. any increase in the capacity of existing
clinical health services;
(19) Expenditures for nonclinical projects,
including parking lots, parking decks, and other parking facilities; computer
systems, software, and other information technology; medical office buildings;
administrative office space; conference rooms; education facilities; lobbies;
common spaces; clinical staff lounges and sleep areas; waiting rooms;
bathrooms; cafeterias; hallways; engineering facilities; mechanical systems;
roofs; grounds; signage; family meeting or lounge areas; other nonclinical
physical plant renovations or upgrades that do not result in new or expanded
clinical health services; and state mental health facilities;
(20) Life plan communities, provided that the
skilled nursing component of the facility is for the exclusive use of residents
of the life plan community and that a written exemption is obtained from the
Department; provided, however, that new sheltered nursing home beds may be used
on a limited basis by persons who are not residents of the life plan community
for a period up to five years after the date of issuance of the initial nursing
home license, but such beds shall not be eligible for Medicaid reimbursement.
For the first year, the life plan community sheltered nursing facility may
utilize not more than fifty percent (50%) of its licensed beds for patients who
are not residents of the life plan community. In the second year of operation,
the life plan community shall allow not more than forty percent (40%) of its
licensed beds for new patients who are not residents of the life plan
community. In the third year of operation, the life plan community shall allow
not more than thirty percent (30%) of its licensed beds for new patients who
are not residents of the life plan community. In the fourth year of operation,
the life plan community shall allow not more than twenty percent (20%) of its
licensed beds for new patients who are not residents of the life plan
community. In the fifth year of operation, the life plan community shall allow
not more than ten percent (10%) of its licensed beds for new patients who are
not residents of the life plan community. At no time during the first five (5)
years shall the life plan community sheltered nursing facility occupy more than
fifty percent (50%) of its licensed beds with patients who are not residents
under contract with the life plan community. At the end of the five (5) year
period, the life plan community sheltered nursing facility shall be utilized
exclusively by residents of the life plan community and at no time shall a
resident of a life plan community be denied access to the sheltered nursing
facility. At no time shall any existing patient be forced to leave the life
plan community to comply with this paragraph. The Department is authorized to
promulgate rules and regulations regarding the use and definition of the term
"sheltered nursing facility" in a manner consistent with Code section.
Agreements to provide continuing care include agreements to provide care for
any duration, including agreements that are terminable by either
party;
(21) Any single specialty
ambulatory surgical center that:
(a)
1. Has capital expenditures associated with
the construction, development, or other establishment of the clinical health
services which do not exceed $2.5 million; or
2. Is the only single specialty ambulatory
surgical center in the county owned by the group practice and has two (2) or
fewer operating rooms; provided, however, that a center exempt pursuant to this
paragraph shall be required to obtain a certificated of need in order to add
any additional operating rooms;
(b) Has a hospital affiliation agreement with
a hospital within a reasonable distance from the facility or the medical staff
at the center has admitting privileges or other acceptable documented
arrangements with such hospital to ensure the necessary backup for the center
for medical complications. The center shall have the capability to transfer a
patient immediately to a hospital within a reasonable distance from the
facility with adequate emergency room services. Hospitals shall not
unreasonably deny a transfer agreement or affiliation agreement to the
center;
(c)
1. Provides care to Medicaid beneficiaries
and, if the facility provides medical care and treatment to children, to
PeachCare for Kids® beneficiaries and provides uncompensated indigent and
charity care in an amount equal to or greater than two percent (2%) of its
adjusted gross revenue, and on or after January 1, 2026, in an amount equal to
or greater than the minimum amount established by the Department shall be
reviewed by the Department every 12 months; or
2. If the center is not a participant in
Medicaid or the PeachCare for Kids® Program, provides uncompensated care to
Medicaid beneficiaries and, if the facility provides medical care and treatment
to children, to PeachCare for Kids® beneficiaries, uncompensated indigent and
charity care, or both in an amount equal to or greater than four percent (4%)
of its adjusted gross revenue, and on or after January 1, 2026, in an amount
equal to or greater than the minimum amount established by the Department which
shall be reviewed by the Department every 12 months; provided, however, single
specialty ambulatory surgical centers owned by physicians in the practice of
ophthalmology shall not be required to comply with this subparagraph;
and
(d) Provides annual
reports in the same manner and in accordance with O.C.G.A. §
31-6-70.
Noncompliance with any condition of this paragraph shall result in a monetary penalty in the amount of the difference between the services which the center is required to provide and the amount actually provided and may be subject to revocation of its exemption status by the Department for repeated failure to pay any fines or moneys due to the Department or for repeated failure to produce data as required by O.C.G.A. § 31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the Georgia Administrative Procedure Act. The dollar amount specified in this paragraph shall be adjusted annually by an amount calculated by multiplying such dollar amount (as adjusted for the preceding year) by the annual percentage of change in the composite index of construction material prices, or its successor or appropriate replacement index, if any, published by the United States Department of Commerce for the preceding calendar year, commencing on July 1, 2009, and on each anniversary thereafter of publication of the index. In calculating the dollar amounts of a proposed project for purposes of this paragraph, the costs of all items subject to review by this chapter and items not subject to review by this chapter associated with an simultaneously developed or proposed with the project shall be counted, except for the expenditure or commitment of or incurring an obligation for the expenditure of funds to develop Certificate of Need applications, studies, reports, schematics, preliminary plans and specifications or working drawings, or to acquire sites;
(22) Any joint venture ambulatory surgical
center that:
(a) Has capital expenditures
associated with the construction, development, or other establishment of the
clinical health service which do not exceed $5 million;
(b)
1.
Provides care to Medicaid beneficiaries and, if the facility provides medical
care and treatment to children, to PeachCare for Kids® beneficiaries and
provides uncompensated indigent and charity care in an amount equal to or
greater than two percent (2%) of its adjusted gross revenue, and on or after
January 1, 2026, in the amount equal to or greater than the minimum amount
established by the Department, which shall be reviewed by the Department every
12 months; or
2. If the center is
not a participant in Medicaid or the PeachCare for Kids® Program, provides
uncompensated care to Medicaid beneficiaries and, if the facility provides
medical care and treatment to children, to PeachCare for Kids® beneficiaries,
uncompensated indigent and charity care, or both in an amount equal to or
greater than four percent (4%) of its adjusted gross revenue, and on and after
January 1, 2026, in an amount equal to or greater than the minimum amount
established by the Department which shall be reviewed by the Department every
12 months; and
(c)
Provides annual reports in the same manner and in accordance with O.C.G.A. §
31-6-70. Noncompliance with any
condition of this paragraph shall result in a monetary penalty in the amount of
the difference between the services which the center is required to provide and
the amount actually provided and may be subject to revocation of its exemption
status by the Department for repeated failure to pay any fines or moneys due to
the Department or for repeated failure to produce data as required by O.C.G.A.
§
31-6-70 after notice to the
exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the
Georgia Administrative Procedure Act. The dollar amount specified in this
paragraph shall be adjusted annually by an amount calculated by multiplying
such dollar amount (as adjusted for the preceding year) by the annual
percentage of change in the composite index of construction material prices, or
its successor or appropriate replacement index, if any, published by the United
States Department of Commerce for the preceding calendar year, commencing on
July 1, 2009, and on each anniversary thereafter of publication of the index.
In calculating the dollar amounts of a proposed project for purposes of this
paragraph, the costs of all items subject to review by this chapter and items
not subject to review by this chapter associated with and simultaneously
developed or proposed with the project shall be counted, except for the
expenditure or commitment of or incurring an obligation for the expenditure of
funds to develop Certificate of Need applications, studies, reports,
schematics, preliminary plans and specifications or working drawings, or to
acquire sites;
(23)
Expansion of services by an imaging center based on a population needs
methodology taking into consideration whether the population residing in the
area served by the imaging center has a need for expanded services, as
determined by the Department in accordance with its rules and regulations, if
such imaging center:
(a) Was in existence and
operational in this state on January 1, 2008;
(b) Is owned by a hospital or by a physician
or a group of physicians comprising at least eighty percent (80%) ownership who
are currently board certified in radiology;
(c) Provides three (3) or more diagnostic and
other imaging services;
(d) Accepts
all patients regardless of ability to pay; and
(e) Provides uncompensated indigent and
charity care in an amount equal to or greater than the amount of such care
provided by the geographically closest general acute care hospital; provided,
however, this paragraph shall not apply to an imaging center in a rural
county;
(24) Diagnostic
cardiac catheterization in a hospital setting on patients fifteen (15) years of
age and older;
(25) Therapeutic
cardiac catheterization in hospitals meeting the following criteria:
A hospital that wishes to receive authorization to perform therapeutic cardiac catheterization procedures must:
1. submit a request for a letter of
determination on the required form with the proper filing fee between May 1 and
May 15 of each year, beginning with calendar year 2009; the sufficiency of the
information submitted in the request shall be determined within the
administrative discretion of the Department;
2. provide documentation which demonstrates
it can perform a minimum of two hundred (200) percutaneous cardiac
interventions (PCI) per year by the beginning of the third year of operation of
a program, including both elective and primary PCI, with a minimum of
thirty-six (36) primary PCI per year beginning the third year of
operation;
3. provide documentation
to support the criteria referenced in subsection 2 above that includes
substantive information on the number of diagnostic cardiac catheterization
procedures performed at the hospital, or referred to existing PCI providers by
the hospital, in or out of the state of Georgia, in the two (2) calendar years
immediately preceding the request;
4. provide documentation that it will have,
prior to beginning a PCI program, on active medical staff, at least one (1)
interventional cardiologist who will meet the American College of Cardiology
(ACC) and American Heart Association (AHA) competency standards, including the
performance of at least seventy-five (75) PCI procedures per year;
5. provide documentation that the
interventional cardiologist is board certified, or is in the process at the
time of the request, of obtaining board certification in Interventional
Cardiology from the American Board of Internal Medicine;
6. provide documentation of access to at
least one (1) other interventional cardiologist who meets the criteria of
subsections 4. and 5. above, to participate in its program on an as-needed
basis as determined by the hospital;
7. agree to report annually the data on
number of PCI procedures, type, and outcomes to the National Cardiovascular
Data Registry Cath/PCI registry;
8.
provide documentation to show that one (1) or more interventional
cardiologist(s), as qualified in subsections 4., 5. and 6. above, are available
to perform primary PCI procedures twenty-four (24) hours a day, seven (7) days
a week, three hundred sixty-five (365) days a year;
9. provide documentation one (1) or more
interventional cardiologist(s) are required to respond to a call, within the
calendar availability specified in subsection 8. above, within sixty (60)
minutes;
10. provide documentation
that competent and trained nursing and technical cardiac catheterization staff
are available at all times and are required to respond in a manner determined
by the hospital in conjunction with the interventional cardiologists;
11. provide documentation of a transfer
agreement with a tertiary medical facility that has an open heart surgery
service to which a patient can be transferred when necessary within a period of
sixty (60) minutes, by any means of transportation as chosen by the hospital,
from the time the need for transfer is identified;
(i) if the provider of an open heart surgery
service within the travel time parameters of this subsection refuses to enter
into a transfer agreement with the requesting hospital, the hospital may submit
documentation on the reasons given for the denial, and the Department may
consider these reasons;
(ii) the
Department may allow a requesting hospital to submit a transfer agreement with
a provider of an open heart surgery service that is beyond the travel time
parameters in this subsection if the reasons given for the denial of a transfer
agreement by the tertiary provider are determined by the Department to be
unreasonable;
(iii) if the
Department determines the reasons for the denial of a transfer agreement by the
tertiary provider within the time travel parameters in this subsection are
reasonable, the Department may require the requesting hospital to address the
reasons for the denial and enter into further negotiations for a transfer
agreement prior to receiving a favorable determination from the
Department;
12. provide
documentation of an agreement with an ambulance service capable of advanced
life support and intra aortic balloon pump services and that guarantees a
thirty (30) minute or less response time;
13. agree to provide accurate and timely
data, including outcomes analysis and formal periodic external and internal
case review as required by the Department;
14. provide documentation to show that
guidelines for determining patients appropriate for PCI procedures in a setting
without on-site open heart backup consistent with C-PORT and ACC standards will
be developed and maintained;
15.
provide documentation to show the cardiac catheterization laboratory(s) at the
requesting hospital is equipped in a manner consistent with C-PORT and ACC
guidelines;
16. agree to
participate in an elective and primary PCI Development Program at its expense,
the successful completion of which will be verified by the Department through
the use of an identified third-party; and
17. affirmatively agree authorization to
begin a therapeutic cardiac catheterization program is expressly contingent
upon successful completion of the development program as referenced in
subsection 16. above.
18. no
hospital shall unreasonably deny a transfer agreement with another hospital.
(b) Any hospital approved to perform
therapeutic cardiac catheterization procedures as a result of a request
submitted between May 1 and May 15 of any calendar year after the adoption of
this rule, must, between May 1 and May 15, of each subsequent year, submit a
request which documents its compliance with the standards of this Rule, and the
Department must re-affirm the hospital's current compliance in writing in order
for the hospital to continue its therapeutic cardiac catheterization
program.
(c) Any administrative
proceeding held pursuant to Ga. Comp. R. & Regs. r.
111-2-2-.10(6), in
opposition to a Department approval of a request from a hospital to perform
therapeutic cardiac catheterization procedures in accordance with the standards
established in this section, or in opposition to a Department decision to deny
a hospital request to perform therapeutic cardiac catheterization procedures,
shall not conduct a de novo review of the Department decision, and such
decision shall only be reversed by an administrative hearing officer upon a
showing the Department's action was without reason, arbitrary, or
capricious;
(26) Infirmaries for facilities operated by,
on behalf of, or under contract with the Department of Corrections or the
Department of Juvenile Justice for the sole and exclusive purpose of providing
health care services in a secure environment to prisoners within a penal
institution, penitentiary, prison, detention center, or other secure
correctional institution, including correctional institutions operated by
private entities in this state which house inmates under the Department of
Corrections or the Department of Juvenile Justice;
(27) The relocation of any skilled nursing
facility, intermediate care facility, or micro-hospital within the same county,
any other health care facility in a rural county within the same county, and
any other health care facility in an urban county within a five-mile radius of
the existing facility so long as the facility does not propose to offer any new
or expanded clinical health services at the new location;
(28) Facilities which are devoted to the
provision of treatment and rehabilitative care for periods continuing for
twenty-four (24) hours or longer for persons who have traumatic brain injury,
as defined in O.C.G.A. §
37-3-1;
(29) The renovation, remodeling,
refurbishment, or upgrading of a health care facility, so long as the project
does not result in any of the following:
(a)
The offering of any new or expanded clinical health services;
(b) Any increase in inpatient bed
capacity;
(c) Any redistribution of
existing beds among existing clinical health services; or
(30) The acquisition of diagnostic,
therapeutic, or other imaging equipment, by or on behalf of:
(a) A hospital; or
(b) An individual private physician or single
group practice of physicians exclusively for use on patients of such private
physician or single group practice of physicians and such private physician or
member of such single group practice of physicians is physically present at the
practice location where the diagnostic or other imaging equipment is located at
least seventy-five percent (75%) of the time that the equipment is in
use.
(31) Any capital
expenditures by a hospital at such hospital's primary campus for:
(a) The expansion or addition of the
following clinical health services: operating rooms, other than dedicated
outpatient operating rooms; medical-surgical services; gynecology; procedure
rooms; intensive care; pharmaceutical services; pediatrics; cardiac care or
other general hospital services; provided, however, that such expenditure does
not include the expansion or addition of inpatient beds or the conversion of
one type of inpatient bed to another type of inpatient bed; or
(b) The movement of clinical health services
from one location on the hospital's primary campus to another location on such
hospital's primary campus.
Pursuant to O.C.G.A. § 31-6-40(c)(1), any person who had a valid exemption granted or approved by the former Health Planning Agency or the Department of Community Health prior to July 1, 2008, shall not be required to obtain a Certificate of Need in order to continue to offer those previously offered services.
(32) New or expanded psychiatric or substance
abuse inpatient programs or state funded beds that serve Medicaid and uninsured
patients that:
(a) Are open 365 days per year,
seven days per week, and 24 hours per day;
(b) Provide uncompensated indigent and
charity care in an amount equal to or greater than 3 percent of its adjusted
gross revenue, and on and after January 1, 2026, in an amount equal to or
greater than the minimum amount established by the department by rule which
shall be at least 3 percent, and which shall be reviewed by the department
every 12 months;
(c) Participate as
providers of medical assistance for Medicaid purposes;
(d) Have hospital affiliation agreements with
acute care hospitals within a reasonable distance from the programs or state
funded beds or the medical staffs at the programs or state funded beds have
admitting privileges or other acceptable documented arrangements with such
hospitals to ensure the necessary backup for the programs or state funded beds
for medical complications. The programs or state funded beds shall have the
capability to transfer a patient immediately to a hospital within a reasonable
distance from the programs or state funded beds with adequate emergency room
services. Acute care hospitals shall not unreasonably deny a transfer agreement
or affiliation agreement with the programs or state funded beds;
(e) Provide annual reports in the same manner
as in accordance with Code Section
31-6-70
Noncompliance with any condition of this subsection shall result in a monetary penalty in the amount of the difference between the services which the exemption holder is required to provide and the amount actually provided and shall be subject to revocation of its exemption status by the Department for repeated failure to meet any one or more requirements for exemption, for repeated failure to pay any fines or moneys due to the Department, or for repeated failure to produce data as required by Code Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act." "Expanded" means exceeding a health car facility's total approved inpatient bed capacity through the addition of beds to an existing CON-authorized or exempt or grandfathered freestanding psychiatric and/or substance abuse hospital.
(33) The offering of new or expanded basic
perinatal services, as defined in Ga. Comp. R. & Regs. r.
111-2-2-.24(2)(a),
by a hospital in a rural county, as defined at Ga. Comp. R. & Regs. r.
111-2-2-.24(2)(k)
provided that:
(a) Such services are
available 365 days per year, seven days per week, and 24 hours per
day;
(b) The hospital participates
as a provider of medical assistance for Medicaid purposes;
(c) The hospital has a hospital affiliation
agreement with an acute care hospital with at least Level III perinatal
services, as defined in Ga. Comp. R. & Regs. r.
111-2-2-.24(2)(c),
within a reasonable distance from the hospital providing the perinatal services
or the medical staff at the hospital providing the perinatal services has
admitting privileges or other acceptable documented arrangements with such
acute care hospital to ensure the necessary backup for the hospital providing
the perinatal services for medical complications. The hospital providing the
perinatal services shall have the capability to transfer a patient immediately
to the acute care hospital within a reasonable distance from the hospital
providing the perinatal services with adequate emergency room services. Acute
care hospitals shall not unreasonably deny a transfer agreement or affiliation
agreement with the hospital providing the perinatal services. This subparagraph
shall not apply if the hospital providing the basic perinatal services is
itself an acute care hospital with at least Level III perinatal services;
and
(d) Provides annual reports in
the same manner and in accordance with Code Section
31-6-70;
Noncompliance with any condition of this subsection shall result in a monetary penalty in the amount of the difference between the services which the exemption holder is required to provide and the amount actually provided and shall be subject to revocation of its exemption status by the Department for repeated failure to meet any one or more requirements for the exemption, for repeated failure to pay any fines or moneys due to the Department, or for repeated failure to produce data as required by ode Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedures Act."
(33.1) Any new or expanded building or
facility where human births occur on a regular and ongoing basis and which is
classified as a birthing center pursuant to Ga. Comp. R. & Regs. r. 111-8-7
et seq., provided that:
(a)
Services are available 365 days per year, seven days per week, and 24 hours per
day;
(b) The birthing center
participates as a provider of medical assistance for Medicaid
purposes;
(c) The birthing center
has a hospital affiliation agreement with an acute care hospital with at least
Level III perinatal services within a reasonable distance from the birthing
center or the medical staff at the birthing center has admitting privileges or
other acceptable documented or medical arrangements with such acute care
hospital to ensure the necessary backup for the birthing center for medical
complications. The birthing center shall have the capability to transfer a
patient immediately to the acute care hospital within a reasonable distance
from the birthing center. Acute care hospitals shall not unreasonably deny a
transfer agreement or affiliation agreement with the birthing center;
(d) The birthing center:
1. Provides basic perinatal services, as
defined at Ga. Comp. R. & Regs. r.
111-2-2-.24(2)(a),
which shall include but not be limited to a combination of such services as
determined by the department;
2.
Meets the standards for certification established by the American Association
of Birthing Centers, or equivalent or higher standards as determined by the
department;
3. Schedules routine
visits and visits with other appropriate providers, as necessary, and tracks
patients to verify that services have been received;
4. Prior to 20 weeks gestation, certifies
that a patient has been deemed to be a low risk patient, as defined by the
department for purposes of this paragraph;
5. Admits and provided services only to
patients certified as low risk; and
6. Refers patients to other appropriate
providers if, at any point between the 20 weeks gestation certification and
antepartum, the birthing center determines that a patient no longer qualifies
as a low risk patient for any reason; and
(e) The birthing center provides annual
reports in the same manner and in accordance with Code Section
3-6-70;
(f) For purposes of this exemption,
"expanded" means any capital renovation or construction project which results
in the addition of a birth room as defined at Ga. Comp. R. & Regs. r.
111-8-7-.01(c).
Noncompliance with any condition of this subsection shall result in a monetary
penalty in the amount of the difference between the services which the
exemption holder is required to provide and the amount actually provided and
shall be subject to revocation of its exemption status by the Department for
repeated failure to meet any one or more requirements for the exemption, for
repeated failure to pay any fines or moneys due to the Department, or for
repeated failure to produce data as required by Code Section
31-6-70 after notice to the
exemption holder and a fair hearing pursuant to Chapter 13 of the Title 50, the
"Georgia Administrative Procedure Act."
(34) A new general acute care hospital in a
rural county, as defined at Ga. Comp. R. & Regs. r.
111-2-2-.20(2)(l)
that:
(a)
1.
Attains status as a teaching hospital, as defined in Ga. Comp. R. & Regs.
r. 111-2-2-.20(2)(p)
withing 36 months of opening, and maintains such status thereafter;
or
2. Obtains verification as a
Level I, II, III, or IV trauma center from the American College of Surgeons
within 36 months of opening, and maintains such verification
thereafter;
(b) Provides
emergency, inpatient, and outpatient psychiatric and behavioral health
services;
(c) Has an emergency
department that is open 365 days per year, seven days per week, and 24 hours
per day;
(d) Provides uncompensated
indigent and charity care in an amount equal to or greater than 3 percent of
its adjusted gross revenue, and on and after January 1, 2026, in an amount
equal to or greater than the minimum amount established by the department by
rule which shall be no less than 3 percent and which shall be reviewed by the
department every 12 months;
(e)
Participates as a provider of medical assistance for Medicaid purposes;
and
(f) Provides annual reports in
the same manner and in accordance with Code Section
31-6-70;
Noncompliance with any condition if this subsection shall result in a monetary penalty in the amount of the difference between the services which the exemption holder is required to provide and the amount actually provided and ball be subject to revocation of its exemption status by the Department for repeated failure to meet any one or more requirements for the exemption, for repeated failure to pay any fines or moneys due to the Department, or for repeated failure to produce data as required by Code Section 3-6-70 after the exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act."
(35) A new acute care hospital where a
short-stay general hospital in a rural county, as defined at Ga. Comp. R. &
Regs., R.
111-2-2-.20(2)(i),
has been closed for more than 12 months and a new replacement hospital has not
opened that:
(a) Is locates in the same rural
county where the short-stay general hospital was closed;
(b) Has no more than the number of licensed
beds that were previously licensed in the closed hospital;
(c) Has an emergency department that is open
365 days per year, seven days per week, and 24 hours per day;
(d) Providers all required clinical health
services as generally offered by a short-stay general hospital to meet
licensure requirements pursuant to Ga. Comp. R. & Regs. r. 111-8-40
et seq.; and
(e)
Providers uncompensated indigent and charity care in an amount equal to or
greater than 3 percent of its adjusted gross revenue, and on and after January
1, 2026, in an amount equal to or greater than the minimum amount established
by the department by rule which shall be no less than 3 percent and which shall
be reviewed by the department every 12 months.
Such acute care hospital may provide basic perinatal services as defined at Ga. Comp. R. & Regs. 111-2-2-.24(2)(a);
(36) A new short-stay
general hospital to address the underserved population previously served by a
short-stay general hospital that was closed within the 48 months preceding the
filing of a request for a letter of determination that:
1. Is located within a county with a
population of more than 1 million according to the United States decennial
census of 2020 or any future such census;
2. Is located within five miles of and in the
same county as the main campus of a medical school that is accredited by the
Liaison Committee on Medical Education to confer Doctor of Medicine (M.D.)
degrees;
3. Has in place at the
time of filing of a request for a letter of determination a written agreement
to serve as a teaching hospital, as defined at Ga. Comp. R. & Regs. r.
111-2-2-.20(2)(p),
for students of the medical school described in division (ii) of this
paragraph;
4. Has a maximum number
of short-stay general hospital beds not greater that 50 percent of the maximum
number of short-stay general hospital beds for which the closed short-stay
general hospital had previously been licensed at any time during the 12 months
prior to its closure;
5. Has an
emergency Department that is open 365 days per year, seven days per week, and
24 hours per day; and
6. Provides
uncompensated indigent and charity care in an amount equal to or greater than 3
percent of its adjusted gross revenue, and on and after January 1, 2026, in an
amount equal to or greater than the minimum amount established by the
department by rule which shall be no less than 3 percent and which shall be
reviewed by the Department every 12 months;
(b) An exemption for a new short-stay general
hospital under this subsection shall include an exemption for all clinical
services and equipment generally utilized at an acute care short-stay general
hospital and required for licensure, including, but not limited to, an
emergency department; Level II perinatal/neonatal services, including labor,
delivery, recovery, and Level II neonatal intermediate care services;
diagnostic imaging services; and surgical services; and
(c) For a period of ten years following the
issuance of its original license, a new short-stay general hospital approved
for an exemption pursuant to this subsection shall be entitled to one or more
determinations from the department to add additional short-stay general
hospital beds, so long as the total licensed capacity of such hospital does not
exceed the maximum number of short-stay general hospital beds for which the
closed short-stay general had previously been licensed at any time during the
12 months prior to its closure; and
(37) Transfer of existing beds from one
general acute care hospital's primary campus to another general acute care
hospital's primary campus within the same hospital system within a 15-mile
radius of the original campus, provided that all of the following are
satisfied:
(a) Both hospitals involved in the
transfer are general acute care hospitals and neither is a specialty
hospital;
(b) Both hospitals
involved in the transfer are under common ownership or control;
(c) The transferring hospital may not, for a
period of 12 months after the transfer is effective, seek to expand the bed
type which was transferred; and
(d)
The transferring hospital is open and operational at the time of transfer and
shall not close within 12 months after the transfer is effective.
(e) Written notice is provided to the
Department within thirty (30) calendar days of the transfer confirming the
number and types of beds transferred and that the transfer complies with all
the requirements of this subsection.
Notes
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No prior version found.