Ga. Comp. R. & Regs. R. 111-2-2-.06 - Application for Certificate of Need
(1)
Letter of Intent. Beginning July 15, 2008, all persons who wish to submit an
application for a Certificate of Need for a new institutional health service or
health ca re facility, as provided in O.C.G.A. §
31-6-40(a) and
(b), must submit a letter of intent notifying
the Department of their intent to do so at least twenty-five (25) days prior to
submission of the Certificate of Need application. The notice must be in
writing, must be submitted via the Department's web portal, and must contain
the following information:
(a) Name and
address of the legal applicant;
(b)
Person to whom inquiries must be addressed;
(c) Name, address of facility, if different
from legal applicant;
(d) Proposed
project site location with specificity;
(e) Brief summary description of
proposal;
(f) Proposed service
area; and
(g) Cost of the project.
The Department will not accept any notices of intent submitted by either telephone, facsimile, or electronic mail, pursuant to Ga. Comp. R. & Regs. r. 111-2-2-.06(6). Beginning with the date referenced above, no Certificate of Need application will be accepted without a previously filed letter of intent. The Certificate of Need application must be submitted no later than twenty-five (25) calendar days after the letter of intent has been received by the Department. In the event that the twenty-fifth (25th) calendar day falls either on a weekend or a legal holiday, the twenty-fifth (25th) calendar day shall become automatically the next business day that is neither a weekend nor a legal holiday. If a Certificate of Need application is not submitted as provided herein, it will not be accepted and an applicant filing an application beyond the time period specified will be required to submit a new letter of intent in the manner specified above.
(2)
Contents of Application.
Applications shall contain all relevant data, information and assurances
required by the Department. The Department will provide application forms on
request, and all applications must be on the form supplied by the Department or
a copy thereof, and comply with the content requirements specified thereon.
Applications shall provide information including, but not necessarily limited
to, the following categories as they relate to the proposed projects:
(a) identification of the
applicant;
(b) ownership;
(c) site identification;
(d) compliance with State and local codes and
ordinances, including flood hazards;
(e) a detailed and complete description of
proposed project;
(f) project
justification, including specific documentation of the need (utilizing the
Department's data and methodology) that the population to be served has for the
project;
(g) staffing and
operation;
(h) financial
information, which shall include positive evidence of ability to obtain
financing, the source of financing, and maximum interest rates, which will be
paid to the lender. Applications submitted for or on behalf of a health care
institution shall include one copy of the latest audit report (or internal
financial statement for investor-owned facilities). Also submitted shall be all
pro forma financial data requested in the application;
(i) cost containment and quality of care
considerations;
(j) project design
and construction schedule including as applicable:
1. Schematic Design Documents meeting the
standards defined by the American Institute of Architects in section 2.4.2 of
the Standard AIA Contract Language. These Schematic Design Documents shall
establish the conceptual design of the Project illustrating the scale and
relationship of the Project components. The Schematic Design Documents shall
also include a conceptual site plan, if appropriate, and preliminary building
plans, sections and elevations. Preliminary selections of major building
systems and construction materials shall be noted on the drawings or described
in writing;
2. A written summary of
the Architect's evaluation and planning findings and recommendations meeting
the standards defined by the American Institute of Architects in section 2.3 of
the Standard AIA Contract Language. This summary shall include, as applicable,
an evaluation of the Applicant's program and schedule requirements and budget
for the Cost of the Work, each in terms of the other, a preliminary evaluation
of the Applicant's site for the Project based on the information provided by
the Applicant of site conditions, and the Applicant's program, schedule and
budget for the Cost of the Work, and an evaluation of the applicant's proposed
method of contracting for construction services; and
3. A detailed description of the proposed
timeline and phases for project completion.
(k) a cost estimate prepared by a licensed
architect or engineer within the sixty (60) days immediately preceding
submission of the application;
(l)
documentation from the Healthcare Facility Regulation Division of no
uncorrected licensure operational standards in the applicant's facility, if
applicable.
(3)
Submittal of Applications.
(a)
Using the Department's web portal, Applicants should submit one (1) copy of the
application signed by the applicant or the legal representative of the
applicant. Failure to do so will result in non-acceptance of the
application.
(b) Applications
received after 3:00 p.m. on any business day will be considered to have been
received on the next business day. Receipt of the application will be
acknowledged in writing by the Department.
(4)
Filing Fee Required.
(a) Each application for a Certificate of
Need review shall be accompanied by a fee, except for the provisions covered in
Ga. Comp. R. & Regs. r.
111-2-2-.06(4)(d)
and Ga. Comp. R. & Regs. r.
111-2-2-.06(4)(e),
the amount of which shall be determined by the following schedule:
1. for applications with a total project cost
from zero to $1,000,000.00, the fee shall be $1,000.00; and
2. for applications with a total project cost
greater than $1,000,000.00, the fee shall be one-tenth of one percent (.001) of
the total cost but not to exceed $50,000.00; and
3.
Reserved.
(b) For any project, which is to
be accomplished by lease, gift or other means of acquisition, the dollar value
for purposes of computing the fee will be based on the value of the major
medical equipment or facilities to be acquired. The value of the major medical
equipment is the expenditure, which would be required for purchase. The value
of the facilities to be acquired is based on a current (within six (6) months
of the submittal of the Certificate of Need application) appraisal of the
property.
(c) Payment of the fee
shall be by credit/debit card via the Department's website, certified check, or
money order made payable to the State of Georgia and must be received by the
Department before an application will be accepted for review. Failure to
provide payment of the appropriate fee will result in non-acceptance of the
application. Fee payments are collected as general State revenue.
(d) State-owned institutions shall be exempt
from payment of a filing fee.
(e)
The Department may waive payment of a filing fee, or any portion thereof, for
certain hospital authority facilities and for certain public non-profit
providers when the Department determines that financial circumstances exist,
which would justify such action. A party requesting a waiver must make such
request at the time the application is submitted to the Department.
(f) Subject to the Rules in (a) through (e)
above, applicants shall submit an additional filing fee for additional
information or amendments provided during the review period that increase the
cost of the project. For such supplementary information which increases the
cost of the project, the amount that shall be submitted is an amount equal to
the difference between the calculation of the filing fee based on the total
amended project costs as outlined in (a) and the filing fee paid at the time of
application, except that in no case shall the amount submitted be less than
$500.00. Should such supplementary information decrease the costs associated
with a project, the filing fee shall not be reduced or refunded. The Department
shall not issue decisions on applications for which such supplementary
information has been provided where an applicant has not submitted the
additional filing fee, as applicable.
(5)
Review for Completeness.
(a) The Department will have 120 days to
review an application, beginning on the day the application is
received.
(b) The Department shall
notify the applicant with seven (7) calendar days following receipt of the
application that the application is complete as submitted or that additional
information is required to complete the application. If additional information
is required, the notice shall include a statement of the specific additional
information required. Notice shall be effective the date it is sent
electronically by the Department.
(c) The Department shall notify the applicant
no later than seven (7) calendar days following receipt of the additional
information whether such additional information is sufficient to complete the
application.
(d) The Department
will deem an application to be withdrawn if the applicant fails to provide the
Department with information sufficient to complete the application, as
requested on a notice of incompleteness, by the 15th
calendar of the review cycle.
(e)
An application will be determined to be incomplete if any of the following were
not either provided with the application or as may be specified in this
Section, submitted previously to the Department:
1. all the required data, information and
assurances provided on the correct forms, including but not limited to the
following:
(i) detailed description of the
proposed project as required by Ga. Comp. R. & Regs. r.
111-2-2-.06(2)(e);
(ii) financial program to meet the
requirements of Ga. Comp. R. & Regs. r.
111-2-2-.06(2)(h);
(iii) documentation of necessary financing
for the project, such as a letter of credit, etc.;
(iv) financial pro forma to meet the
requirements of Ga. Comp. R. & Regs. r.
111-2-2-.06(2)(h);
and
(v) most recent audited
financial statements, or personal financial statements if audited statements
are not available (tax returns would meet this requirement for unaudited
entities and individuals);
(vi) for
projects invoking service-specific Rules, as outlined in Ga. Comp. R. &
Regs. r. 111-2-2-.20 et
seq., the appropriate service-specific review considerations;
(vii) for projects involving construction,
renovation, and/or expansion, schematic plans and cost estimates certified by
an architect, engineer, or general contractor, as appropriate and as required
by Ga. Comp. R. & Regs. r.
111-2-2-.06(2)(j) and
(k);
(viii) for projects involving the acquisition
of equipment, purchase orders or invoices, as appropriate;
2. signature of the applicant;
3. payment of the filing fee, as described in
Ga. Comp. R. & Regs. r.
111-2-2-.06(4);
4. the most recent three (3) years of all
required surveys, as may be previously submitted to the Department, including
the Annual Hospital Questionnaire, Annual Nursing Home Questionnaire, survey of
home health agencies, or other data-gathering instruments required by the
Department for any health care facilities and services owned or operated by the
applicant, to include data requested pursuant to O.C.G.A. §
31-6-70. In order for an
application to be deemed complete, such surveys and data-gathering instruments
shall be complete and accurate, as determined by the Department. Further, an
application submitted by a component of an entity which owns or operates other
health care facilities will be determined to be incomplete unless all health
care facilities under the same ownership or operation have submitted completed
questionnaires with to Department;
5. written verification certifying
entitlement to any necessary real estate property or leasehold as described by
the applicant in the application. Verification of entitlement shall include,
but not be limited to, deeds, contracts, lease arrangements, conditional sales
agreements or a comparable arrangement that purports to be a transfer of
ownership in whole or in part. If an unsigned lease arrangement is submitted,
the Applicant shall also submit an original letter documenting both the
lessor's and lessee's commitment to participate in the lease once the CON is
approved;
6. authorization to
conduct business, including but not limited to, as appropriate:
(i) if the applicant is an entity requiring
authorization by the Secretary of State to become a legal entity entitled to do
business in the State of Georgia, such documentation;
(ii) by-laws, articles of incorporation, or
articles of organization; and
(iii)
if the applicant is an existing and licensed or permitted entity, a copy of
such license or permit.
7. The applicant shall file one copy of the
application with the office of the County Commissioner of the county in which
the project exists or is proposed. The applicant shall submit with the
application an exact copy of the letter addressed and submitted to the County
Commission that accompanied the submittal of the application to the County
Commission;
8. all post-approval
reporting requirements as mandated at Ga. Comp. R. & Regs. r.
111-2-2-.04(2) for
all previously approved projects, as may be previously submitted to the
Department. Further, an application submitted by a component of an entity which
owns or operates other health care facilities will be determined to be
incomplete unless all health care facilities under the same ownership or
operation have met the said post-approval reporting requirements for all
previously approved projects with the Department;
9. the written vendor lobbyist certification
required by Ga. Comp. R. & Regs. r.
111-1-2-.03(2);
10. In order to be determined complete, an
applicant must be current will all indigent and charity care commitments, if
any, made to the Department as a condition or requirement for past approval of
a project. Further, an application submitted by a component of an entity which
owns or operates other health care facilities will be determined to be
incomplete unless all health care facilities under the same ownership or
operation are current with any and all indigent and charity care commitments
made to the Department; and
11. In
order to be determined complete, an applicant must be current with any and all
fines, if any, levied by the Department for violation of these Rules.
12. No applicant for a new Certificate of
Need, a modification to an existing Certificate of Need, or a conversion of a
Certificate of Need that has any outstanding amounts owed to the state
including fines, penalties, fees, or other payments for noncompliance with any
requirements contained in O.C.G.A. §§
31-6-40.1,
31-6-45.2,
31-6-70,
31-7-280, or
31-8-179.2 shall be eligible to
receive a new Certificate of Need or a modification to an existing Certificate
of Need unless such applicant pays such outstanding amounts to the state. Any
such fines, penalties, fees, or other payments for noncompliance shall be
subject to the same notices and hearing for the levy of fines under O.C.G.A. §
31-6-45.
(f) In addition to the provisions of a
paragraph (b) above, additional requirements shall be in effect where the
application involves the acquisition of a hospital owned or operated by or on
behalf of a political subdivision, any combination of such subdivisions, or by
or on behalf of a hospital authority. These requirements shall be as follows:
1. in the event that a health care facility,
which has been assisted at any time during the past twenty years through a
grant of State funds, is proposed to be acquired by a non-grant-eligible
entity, the Department, in accordance with O.C.G.A. §§
31-7-53(c) and
31-7-57(d), is
required to recover the funds granted by the State. A commitment regarding
return to the State of such monies consistent with the Code should be forwarded
to the Department no later than the end of the review period.
2. there shall be submitted a written
agreement between the parties containing the following commitments:
(i) that the purchaser or lessee will
annually allocate funds for the purpose of providing indigent/charity care. The
funds allocated will be no less than three percent (3%) of the gross revenues
of the hospital after provisions for bad debt and Medicaid and Medicare
contractual adjustments have been deducted. The funds allocated will be based
on the previous year's financial records, except the first year of operation
following an acquisition the three percent (3%) will be based on the gross
revenues of the hospital after provisions for bad debt and Medicaid and
Medicare adjustments have been deducted. For purposes of this Rule; gross
revenues will include all income derived from all sources;
(ii) that the purchaser will agree that no
resident of the county in which the hospital resides will be denied emergency
care (including emergency obstetrical care) due to inability to pay;
(iii) that the purchaser will participate in
the Medicaid and Medicare programs and the State Health Benefit Plan, if
authorized by the Department.
(6)
Submission of Information and
Documents.
For the purposes of meeting any deadlines imposed by either these Rules or O.C.G.A. § 31-6-1et seq, all information and documents shall be submitted electronically through the Department's designated web portal. Except as otherwise provided, information and documents received after 5:00 p.m. on any business day will be considered to have been received on the next business day.
Notes
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