HB 1393: Hospitals; allow rural hospitals to join together to allow further purchasing power with third-party payors but retain their independence

Georgia currently requires most hospitals and healthcare facilities to get a 'certificate of need' (state permission based on need and cost) before building, expanding, or offering new services. This bill repeals that requirement for nearly every type of facility, but keeps a certificate of need program specifically for skilled nursing facilities, run by the Department of Community Health. It rewrites the rules for how that narrower program works: applications, indigent care conditions, appeal hearings before a reconstituted Certificate of Need Appeal Panel, revocation, fines, and exemptions. The bill also makes dozens of conforming changes across other titles of Georgia law to remove references to certificate of need requirements that no longer apply. Separately, it creates a new legal framework letting rural hospital authorities (in counties under 50,000 people) merge, share staff, jointly negotiate with insurers, and collaborate with up to two other rural hospital authorities, while granting them immunity from federal and state antitrust laws after notice to and review by the Attorney General. The law would take effect as soon as the Governor signs it.

• Repeals Georgia's certificate of need requirement (Chapter 6 of Title 31) for nearly all healthcare facilities except skilled nursing facilities, which keep a revised certificate of need program run by the Department of Community Health.
• Creates a reconstituted five-member Certificate of Need Appeal Panel to hear appeals of skilled nursing facility certificate decisions, with set timelines for hearings and judicial review.
• Sets penalties for skilled nursing facilities that operate without a required certificate of need, ranging from $5,000 to $25,000 per day depending on how long the violation continues.
• Deems any pending certificate of need applications and appeals for non-skilled-nursing facilities withdrawn or dismissed as of the bill's effective date.
• Creates a new legal framework allowing rural hospital authorities to merge, share staff, jointly purchase supplies, and jointly negotiate with insurers with up to two other rural hospital authorities.
• Grants rural hospital authorities immunity from federal and state antitrust laws for these collaborative activities, subject to notice to and review by the Attorney General.

Hospitals, nursing homes, ambulatory surgical centers, imaging centers, and other healthcare facilities statewide that currently need certificates of need; skilled nursing facilities specifically, which remain under the revised program; the Department of Community Health and its new appeal panel; rural hospital authorities in counties under 50,000 people; and insurers and other payors that would negotiate with newly consolidated rural hospital groups.

Most Georgia hospitals and healthcare facilities would no longer need state approval to build or expand services, which could speed up new construction and services but remove a review meant to limit oversupply. Rural hospitals gain new tools to combine operations and negotiate jointly with insurers without antitrust exposure, potentially strengthening their bargaining power and financial stability.

• Section 1-1 repeals and replaces Chapter 6 of Title 31, narrowing certificate of need review to skilled nursing facilities and defining terms like 'new institutional health service' and 'bed capacity.'
• New Code Section 31-6-40 requires certificates of need only for new, expanded, or relocated skilled nursing facilities and new clinical services at existing ones, effective July 1, 2026.
• New Code Section 31-6-46 recreates the Certificate of Need Appeal Panel with five gubernatorially appointed attorney members serving up to four-year terms, who conduct de novo appeal hearings.
• New Code Section 31-6-48 sets escalating daily fines ($5,000 to $25,000) for operating a new institutional health service without a required certificate of need.
• Part II (Sections 2-1 through 2-22) makes dozens of conforming edits across Titles 16, 31, 33, 37, 43, 50, and 51 to remove obsolete certificate of need references now that the requirement is narrowed.
• New Code Sections 31-7-100 through 31-7-106 (Part III) let rural hospital authorities in counties under 50,000 people merge, share services, and jointly negotiate with payors with up to two other rural hospital authorities.
• Rural hospital authorities must notify the Governor, Attorney General, and legislative leaders and undergo a 180-day Attorney General review before their antitrust immunity takes effect.
• The bill takes effect immediately upon the Governor's signature or upon becoming law without signature (Section 4-1).

1. 2026-03-31Senate Tabled (Senate)
2. 2026-03-27Senate Read Second Time (Senate)
3. 2026-03-27Senate Committee Favorably Reported By Substitute (Senate)
4. 2026-03-06Senate Read and Referred (Senate)
5. 2026-03-04House Passed/Adopted By Substitute (House)
6. 2026-03-04House Third Readers (House)
7. 2026-03-03House Committee Favorably Reported By Substitute (House)
8. 2026-02-20House Second Readers (House)

• William Werkheiser (R, HD-157)Primary sponsor
• Angie O'Steen (R, HD-169)
• Leesa Hagan (R, HD-156)
• James Burchett (R, HD-176)
• Butch Parrish (R, HD-158)
• John Corbett (R, HD-174)
• Ben Watson (R, SD-001)

1. PassedHouse voteMarch 4, 2026

   170 yea, 0 nay (2 not voting, 5 absent)

   Passage: House Vote #619

2. PassedSenate voteMarch 31, 2026

   39 yea, 10 nay (2 not voting, 3 absent)

   Motion To Table Remaining Legislation On The Rules Calendar: Senate Vote #912

• certificate of need
• rural hospitals
• skilled nursing facilities
• hospital regulation
• antitrust immunity