Ga. Comp. R. & Regs. R. 111-2-2-.32 - Specific Review Considerations for Home Health Services
(1)
Applicability. A Certificate
of Need for a home health agency will be required prior to the establishment of
a new home health agency or the expansion of the geographic service area of an
existing home health agency unless such expansion is a result of a
non-reviewable acquisition of another existing home health agency.
(2)
Definitions.
(a) "Home health agency" means a public
agency or private organization, or a subdivision of such an agency or
organization, which is primarily engaged in providing to individuals who are
under a written plan of care of a physician, on a visiting basis in the place
of residence used as such individual's home, part-time or intermittent nursing
care provided by or under the supervision of a registered professional nurse,
and one or more of the following services: physical therapy, occupational
therapy, speech therapy, medical-social services under the direction of a
physician, or part-time or intermittent services of a home health
aide.
(b) "Horizon year" means the
last year of the three-year projection period for need determinations for a new
or expanded home health agency.
(c)
"Geographic service area" means a grouping of specific counties within a
planning area for which the home health agency is authorized to provide
services to individuals residing in the specific counties pursuant to an
existing or future Certificate of Need. For purposes of establishing a service
area for a new home health agency, the geographic service area shall consist of
any individual county or combination of contiguous counties which have an unmet
need as determined through the numerical need formula or the exception. For
purposes of an expansion of an existing agency, the geographic service area
shall consist of an individual county or any combination of counties which have
an unmet need, and which are within any planning area in which the home health
agency already provides service; however, in no case may an existing home
health agency apply to provide services outside the health planning areas in
which its current geographic service area is located.
(d) "Nursing care" means such services
provided by or under the supervision of a licensed registered professional
nurse in accordance with a written plan of medical care by a physician. Such
services shall be provided in accordance with the scope of nursing practice
laws and associated rules.
(e)
"Planning area" for all home agencies means the geographic regions in Georgia
defined in the State Health Plan or Component Plan.
(3)
Standards.
(a) The need for a new or expanded home
health agency shall be determined through application of a numerical need
method and an assessment of the projected number of patients to be served by
existing agencies.
1. The numerical need for
a new or expanded home health agency in any planning area in the horizon year
shall be based on the estimated number of annual home health patients within
each health planning area as determined by a population-based formula which is
a sum of the following for each county within the health planning area:
(i) a ratio of 4 patients per 1,000 projected
horizon year Resident population age 17 and younger;
(ii) a ratio of 5 patients per 1,000
projected horizon year Resident population age 18 through 64;
(iii) a ratio of 45 patients per 1,000
projected horizon year Resident population age 65 through 79; and
(iv) a ratio of 185 patients per 1,000
projected horizon year Resident population age 80 and older.
2. The net numerical unmet need
for home health services shall be determined by subtracting the projected
number of patients for the current calendar year from the projected need for
services as calculated in (3)(a)1. The projected number of patients for the
current calendar year is determined by multiplying the number of patients
having received services in each county, as reported in the most recent survey
year, by the county population change factor. The county population change
factor is the percent change in total population between the most recent survey
year and the current calendar year.
(b)
1. The
Department shall accept applications for review as enumerated below:
(i) If the net numerical unmet need in a
given planning area is 250 patients or more, the Department shall authorize the
submission of applications for an expanded home health agency; or
(ii) If the net numerical unmet need in a
given planning area is 500 patients or more, the Department shall authorize the
submission of applications for a new home health agency as well as an expanded
home health agency.
2. An
applicant must propose to provide service only within a county or group of
counties, each of which reflects a numerical unmet need, and contained within
the given planning area for which the Department has authorized the submission
of applications.
3. The Department
shall only approve applications in which the applicant has applied to serve all
of the unmet numerical need in any one county in which need is projected. The
need within counties shall not be divided or shared between any two or more
applicants.
(c) The
Department may authorize an exception to Ga. Comp. R. & Regs. r.
111-2-2-.32(3)(a)
if:
1. the applicant for a new or expanded
home health agency can show that there is limited access in the proposed
geographic service area for special groups such as, but not limited to,
medically fragile children, newborns and their mothers, and HIV/AIDS patients.
For purposes of this exception, an applicant shall be required to document,
using population, service, special needs and/or disease incidence rates, a
projected need for services in the planning area of at least 200 patients
within a defined geographic service area. A successful applicant applying under
this section will be restricted to serving the special group or groups
identified in the application within the county or counties stipulated in the
application; or
2. a particular
county is served by no more than two (2) home health agencies and either of the
following conditions exists:
(1) less than
one percent (1%) of the county's population has received home health services,
or
(2) one of the two home health
agencies has demonstrated a failure to adequately serve Medicaid patients as
evidenced by a level of service to such individuals that is less than the
statewide average within each of the past two years as reported on the Annual
Home Health Services survey. For purposes of this exception, an applicant must
already be approved to provide service in a contiguous county or be approved to
provide service in a county that is no further than 15 miles from the county
authorized through the exception. In all other aspects of the application
process, the applicant shall be required to comply with provisions applicable
to expanded home health agencies. For purposes of this exception, "served by"
shall mean the agency(ies) are licensed to serve the county by the Healthcare
Facility Regulation Division of the Georgia Department of Community
Health.
(d) An
applicant for a new or expanded home health agency shall provide a community
linkage plan which demonstrates factors such as, but not limited to, referral
arrangements with appropriate services of the healthcare system and working
agreements with other related community services assuring continuity of care
focusing on coordinated, integrated systems which promote continuity rather
than acute, episodic care. Working agreements with other related community
services may include the ability to streamline referrals to other appropriate
services and to participate in the development of cross-continuum care plans
with other providers.
(e) An
applicant for a new or expanded home health agency shall provide a written
statement of its intent to comply with all appropriate licensure requirements
and operational procedures required by the Healthcare Facility Regulation
Division of the Georgia Department of Community Health.
(f) An applicant for a new or expanded home
health agency or agency(ies) owned and/or operated by the applicant or its
parent organization shall have no history of uncorrected or repeated
conditional level violations or uncorrected standard deficiencies as identified
by licensure inspections or equivalent deficiencies as noted from Medicare or
Medicaid audits.
(g) An applicant
for a new or expanded home health agency or agency(ies) owned and/or operated
by the applicant or its parent organization shall have no previous conviction
of Medicaid or Medicare fraud.
(h)
An applicant for a new or expanded home health agency shall provide a written
plan which demonstrates the intent and ability to recruit, hire and retain the
appropriate numbers of qualified personnel to meet the requirements of the
services proposed to be provided and that such personnel are available in the
proposed geographic service area.
(i) An applicant for a new home health agency
shall provide evidence of the intent to meet the appropriate accreditation
requirements of The Joint Commission (TJC), the Community Health Accreditation
Program, Inc. (CHAP), and/or other appropriate accrediting agencies.
(j) An applicant for an expanded home health
agency shall provide documentation that they are fully accredited by The Joint
Commission (TJC), the Community Health Accreditation Program, Inc. (CHAP),
and/or other appropriate accrediting agency.
(k) An applicant for a new or expanded home
health agency shall provide its existing or proposed plan for a comprehensive
quality improvement program.
(l) An
applicant for a new or expanded home health agency shall assure access to
services to individuals unable to pay and to all individuals regardless of
payment source or circumstances by:
1.
providing evidence of written administrative policies that prohibit the
exclusion of services to any patient on the basis of age, disability, gender,
race, or ability to pay;
2.
providing a written commitment that services for indigent and charity patients
will be offered at a standard which meets or exceeds one percent (1%) of
annual, adjusted gross revenues for the home health agency or, in the case of
an applicant providing other health services, the applicant may request that
the Department allow the commitment for services to indigent and charity
patients to be applied to the entire facility;
3. providing documentation of the
demonstrated performance of the applicant, and any facility in Georgia owned or
operated by the applicant's parent organization, of providing services to
Medicare, Medicaid, and indigent and charity patients;
4. providing a written commitment to
participate in the Medicare, Medicaid and PeachCare for Kids® programs;
and
5. providing a written
commitment to participate in any other state health benefits insurance programs
for which the home health service is eligible.
(m) An applicant for a new or expanded home
health agency shall demonstrate that their proposed charges compare favorably
with the charges of existing home health agencies in the same geographic
service area.
(n) An applicant for
a new or expanded home health agency shall document an agreement to provide
Department requested information and statistical data related to the operation
and provision of home health services and to report that data to the Department
in the time frame and format requested by the Department.
(o) The Department may authorize an existing
home health agency to transfer one county or several counties to another
existing home health agency without either agency being required to apply for a
new or expanded Certificate of Need, provided the following conditions are met:
1. the two agencies agree to the transfer and
submit such agreement and a joint request to transfer in writing to the
Department at least thirty (30) days prior to the proposed effective date of
the transfer;
2. the two agencies
document within the written request that the transfer would result in increased
and improved services for the residents of the county or counties including
Medicare and Medicaid patients;
3.
the agency to which the county or counties are being transferred currently
offers services in at least one contiguous county or within the health planning
area(s) in which county or counties are located; and
4. the two agencies are in compliance with
all other requirements of these Rules; such compliance to be evaluated with the
written transfer request.
No such transfer shall become effective without written approval from the Department.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.