HB1393: HB1393 Hospitals; allow rural hospitals to join together to allow further purchasing power with third-party payors but retain their independence

Georgia currently requires many healthcare facilities to get a 'certificate of need' (state permission based on community need) before building or expanding services. This bill repeals that broad requirement and replaces it with a narrower certificate of need program that applies only to skilled nursing facilities and related services. It creates new rules for how the Department of Community Health reviews applications, sets up a five-member Certificate of Need Appeal Panel, spells out penalties for operating without a certificate, and lists many exemptions (federal facilities, minor repairs, parking lots, and more). Separately, the bill creates a new legal framework letting 'rural hospital authorities' (hospital authorities in counties under 50,000 people) merge, share staff, jointly negotiate with insurers, and otherwise coordinate with up to two other rural hospital authorities or rural physician practices. These activities get limited immunity from federal antitrust law, subject to notice to and review by the Attorney General. The bill also makes numerous conforming changes across other Georgia code titles and takes effect when signed by the Governor.

• Repeals Georgia's existing certificate of need law (O.C.G.A. Chapter 31-6) and replaces it with a narrower version that applies only to skilled nursing facilities and related clinical services.
• Requires the Department of Community Health to write rules, define need methodologies, set fees, and review applications for new skilled nursing facility projects.
• Recreates a five-member Certificate of Need Appeal Panel appointed by the Governor to hear appeals of the department's certificate decisions.
• Sets penalties for offering services without a certificate, ranging from $5,000 to $25,000 per day depending on how long the violation continues.
• Creates a new legal category of 'rural hospital authority' and lets these authorities merge, share staff, jointly negotiate contracts, and coordinate services with up to two other rural hospital authorities or rural physician practices.
• Grants rural hospital authorities limited immunity from federal antitrust laws for this coordinated activity, conditioned on notice to and review by the Attorney General.

Skilled nursing facilities and their operators, applicants seeking to build or expand nursing facilities, the Department of Community Health and its new appeal panel, rural hospital authorities and rural physician practices in counties under 50,000 people, the Attorney General's office, and indirectly patients and insurers dealing with these facilities.

Most Georgia hospitals and other healthcare facilities would no longer need state approval before adding services or expanding, while nursing home construction would still face review. Rural hospitals could legally combine operations and negotiate jointly with insurers, changes that could affect local healthcare access, pricing, and competition in rural communities.

• New Code Section 31-6-1 through 31-6-53 (Part I) narrows the certificate of need requirement so it applies only to skilled nursing facilities, not hospitals or other healthcare facilities generally.
• Section 31-6-45 sets a 120-day review period for applications, extendable by 30 days, with rules for letters of intent, batching cycles, and opposition procedures.
• Section 31-6-46 recreates the Certificate of Need Appeal Panel with five Governor-appointed attorneys serving up to four-year terms to hear appeals as a de novo review.
• Section 31-6-48 authorizes daily fines of $5,000 to $25,000 for facilities that offer services without a required certificate, scaling up the longer the violation continues.
• Section 31-6-52 lists 15 categories of exemptions from certificate of need review, including federal facilities, minor repairs, and nonclinical construction like parking lots.
• Part III adds new Article 4A to Chapter 7 of Title 31, letting rural hospital authorities in counties under 50,000 people merge, jointly negotiate, and share services with up to two other such authorities.
• Section 31-7-106 requires rural hospital authorities to notify the Governor, Attorney General, and legislative leaders before claiming antitrust immunity, and gives the Attorney General up to 180 days to review the claim.
• Part IV sets the effective date as the date the Governor signs the bill or it otherwise becomes law without signature.

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
• nursing homes
• healthcare regulation
• antitrust immunity