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

26 LC 52 1109S The Senate Committee on Health and Human Services offered the following substitute to HB 1393: A BILL TO BE ENTITLED AN ACT To amend Title 31 of the Official Code of Georgia Annotated, re lating to health, so as to1 provide for government efficiency and improved regulation of he althcare facilities and2 hospital authorities in order to maximize the provision of quality and affordable healthcare3 services throughout the state; to eliminate certificate of need requirements for all healthcare4 facilities except certain skilled nursing facilities and relate d services; to provide for the5 certificate of need program for skilled nursing facilities; to authorize the Department of6 Community Health to administer such program; to provide for rules promulgation; to provide7 for new institutional health services; to provide for exemptions; to provide for resolution of8 prior applications; to provide for applications; to provide for indigent care requirements; to9 provide for scope and term of validity of certificate; to provi de for qualifications for10 issuances of certification; to require applicants to pay certain outstanding debts; to provide11 for letters of intent; to provide for acceptance or rejection of applications; to provide for the12 recreation of the Certificate of Need Appeal Panel; to provide for appeal procedure and13 judicial review; to provide for discretionary and automatic rev ocation; to provide for14 participation as a Medicaid provider; to provide for the Department of Community Health15 to submit annual reports; to provide for exemptions for the cer tificate of need program; to16 provide for resolution of matters under review no longer applicable; to allow rural hospital17 authorities to engage in coordi nated healthcar e planning and de livery; to provide for18 - 1 - 26 LC 52 1109S legislative declarations, findings, and intentions; to provide for corporate restructuring; to19 provide for strategic alliances; to provide for shared staffing; to provide for joint purchasing20 arrangements and shared services agreements; to provide for shared information; to provide21 for integrated networks; to provide for collaborative activitie s; to provide for limited22 immunity to antitrust liability; to provide for notice; to provide for review by the Attorney23 General; to provide for aggrieved parties; to provide for appeals; to provide for guidance; to24 provide for review of conduct; to amend other provisions in var ious titles of the Official25 Code of Georgia Annotated, so as to make conforming changes; to provide for definitions;26 to provide for narrow construction; to provide for related matters; to provide for an effective27 date; to repeal conflicting laws; and for other purposes.28 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:29 PART I30 Certificate of need program31 SECTION 1-1.32 Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by33 repealing Chapter 6, relating to state health planning and development, and enacting a new34 Chapter 6 to read as follows:35 "CHAPTER 636 ARTICLE 137 31-6-1.38 As used in this chapter, the term:39 - 2 - 26 LC 52 1109S (1) 'Application' means a written request for a certificate of need made to the department,40 containing such documentation and information as the department may require.41 (2) 'Bed capacity' means space used exclusively for inpatient care, including space42 designed or remodeled for inpatient beds even when not used for such purposes. The43 number of beds to be counted in any patient room shall be the m aximum number for44 which adequate square footage is provided as established by rul es of the department,45 except that single beds in single rooms shall be counted even i f the room contains46 inadequate square footage.47 (3) 'Board' means the Board of Community Health established under Chapter 2 of this48 title.49 (4) 'Certificate of need' means an official finding by the dep artment, evidenced by50 certification issued pursuant to an application, that the action proposed in the application51 satisfies and complies with the criteria contained in this chapter and rules promulgated52 pursuant hereto.53 (5) 'Certificate of Need Appeal Panel' or 'appeal panel' means the panel of independent54 hearing officers created pursuant to Code Section 31-6-46 to conduct appeal hearings.55 (6) 'Clinical health services' means diagnostic, treatment, or rehabilitative services56 provided in a skilled nursing facility and includes inpatient n ursing care, whether57 intermediate, skilled, or extended care.58 (7) 'Commissioner' means the commissioner of community health established under59 Chapter 2 of this title.60 (8) 'Department' means the Department of Community Health esta blished under61 Chapter 2 of this title.62 (9) 'Develop,' with reference to a project, means constructing, remodeling, installing, or63 proceeding with a project, or any part of a project, or a capit al expenditure project, the64 cost estimate for which exceeds $10 million. Notwithstanding t he provisions of this65 paragraph, the expenditure or commitment or incurring an obligation for the expenditure66 - 3 - 26 LC 52 1109S of funds to develop certificate of need applications, studies, reports, schematics,67 preliminary plans and specifications, or working drawings or to acquire, develop, or68 prepare sites shall not be considered to be the developing of a project.69 (10) 'New institutional health service' shall have the same me aning as described in70 subsection (a) of Code Section 31-6-40.71 (11) 'Offer' means that a skilled nursing facility is open for the acceptance of patients or72 performance of services and has qualified personnel, equipment, and supplies necessary73 to provide specified clinical health services.74 (12) 'Person' means any individual, trust or estate, partnership, limited liability company75 or partnership, corporation (including associations, joint-stock companies, and insurance76 companies), state, political subdivision, hospital authority, or instrumentality (including77 a municipal corporation) of a state as defined in the laws of t his state. This term shall78 include all related parties, including individuals, business co rporations, general79 partnerships, limited partnerships, limited liability companies , limited liability80 partnerships, joint ventures, nonprofit corporations, or any other for profit or not for profit81 entity that owns or controls, is owned or controlled by, or ope rates under common82 ownership or control with a person.83 (13) 'Project' means a proposal to take an action for which a certificate of need is84 required under this chapter. A project or proposed project may refer to the proposal from85 its earliest planning stages up through the point at which the new institutional health86 service is offered.87 (14) 'Skilled nursing facility' means a public or private institution or a distinct part of an88 institution which is primarily engaged in providing inpatient s killed nursing care and89 related services for patients who require medical or nursing care or rehabilitation services90 for the rehabilitation of injured, disabled, or sick persons.91 (15) 'State health plan' means a comprehensive program based on recommendations by92 the Health Strategies Council and the board, approved by the Governor, and implemented93 - 4 - 26 LC 52 1109S by the State of Georgia for the purpose of providing adequate h ealthcare services and94 facilities throughout the state.95 ARTICLE 296 31-6-20.97 (a) The department is authorized to administer the certificate of need program established98 under this chapter and, within the appropriations made available to the department by the99 General Assembly of Georgia and consistently with the laws of the State of Georgia, a state100 health plan adopted by the board. The department shall review and update the state health101 plan at least every five years to ensure the plan meets the evolving needs of the state. The102 department shall provide, by rule, for procedures to administer its functions unless103 otherwise provided by the board.104 (b) The functions of the department shall be:105 (1) To conduct the health planning activities of the state and to implement those parts of106 the state health plan which relate to the government of the state;107 (2) To prepare and revise a draft state health plan;108 (3) To adopt, promulgate, and implement rules and regulations sufficient to administer109 the provisions of this chapter including the certificate of need program;110 (4) To define, by rule, the form, content, schedules, and proc edures for submission of111 applications for certificates of need, other determinations, and periodic reports;112 (5) To establish time periods and procedures consistent with this chapter to hold hearings113 and to obtain the viewpoints of interested persons prior to iss uance or denial of a114 certificate of need;115 (6) To provide, by rule, for such fees as may be necessary to cover the costs of hearing116 officers, preparing the record for appeals before such hearing officers and the Certificate117 of Need Appeal Panel of the decisions of the department, and other related administrative118 - 5 - 26 LC 52 1109S costs, which costs may include reasonable sharing between the department and the parties119 to appeal hearings;120 (7) To establish, by rule, service-specific need methodologies and criteria for new skilled121 nursing facilities. In developing such need methodologies, the department shall, at a122 minimum, consider the demographic characteristics of the population, the health status123 of the population, service use pa tterns, standards and trends, financial and geographic124 accessibility, and market economics;125 (8) To provide, by rule, for a reasonable and equitable fee schedule for certificate of need126 applications;127 (9) To grant, deny, or revoke a certificate of need as applied for or as amended; and128 (10) To perform powers and functions delegated by the Governor, which delegation may129 include the powers to carry out the duties and powers which have been delegated to the130 department under Section 1122 of the federal Social Security Act of 1935, as amended.131 (c) The commissioner shall have the power to establish and abo lish technical advisory132 committees as he or she deems necessary, in consultation with t he board, to inform133 effective strategy development and execution.134 31-6-21.135 (a) Rules of the department shall be adopted, promulgated, and implemented as provided136 in this Code section and in Chapter 13 of Title 50, the 'Georgia Administrative Procedure137 Act,' except that the department shall not be required to compl y with subsections (c)138 through (g) of Code Section 50-13-4.139 (b) The department shall transmit three copies of the notice provided for in paragraph (1)140 of subsection (a) of Code Section 50-13-4 to the legislative counsel. The copies shall be141 transmitted at least 30 days prior to the department's intended action. Within five days142 after receipt of the copies, if possible, the legislative couns el shall furnish the presiding143 officer of each house with a copy of the notice and mail a copy of the notice to each144 - 6 - 26 LC 52 1109S member of the Senate Health and Human Services Committee and ea ch member of the145 House Committee on Health and Human Services. Each such rule promulgated pursuant146 to subsection (a) of this Code section and any part thereof shall be subject to the making147 of an objection by either such committee within 30 days of transmission of the rule to the148 members of such committee. Any rule or part thereof to which n o objection is made by149 both such committees may become adopted by the department at the end of such 30 day150 period. The department may not adopt any such rule or part the reof which has been151 changed since having been submitted to such committees unless:152 (1) That change is to correct only typographical errors;153 (2) That change is approved in writing by both committees and that approval expressly154 exempts that change from being subject to the public notice and hearing requirements of155 subsection (a) of Code Section 50-13-4;156 (3) That change is approved in writing by both committees and is again subject to the157 public notice and hearing requirements of subsection (a) of Code Section 50-13-4; or158 (4) That change is again subject to the public notice and hear ing requirements of159 subsection (a) of Code Section 50-13-4 and the change is submitted and again subject to160 committee objection as provided in this subsection.161 Nothing in this subsection shall prohibit the department from a dopting any rule or part162 thereof without adopting all of the rules submitted to the committees if the rule or part so163 adopted has not been changed since having been submitted to the committees and objection164 thereto was not made by both committees.165 (c) Any rule or part thereof to which an objection is made by both committees within the166 30 day objection period under subsection (b) of this Code section shall not be adopted by167 the department and shall be invalid if so adopted. A rule or p art thereof thus prohibited168 from being adopted shall be deemed to have been withdrawn by the department unless the169 department, within the first 15 days of the next regular session of the General Assembly,170 transmits written notification to each member of the objecting committee or committees171 - 7 - 26 LC 52 1109S that the department does not intend to withdraw that rule or pa rt thereof but intends to172 adopt the specified rule or part effective the day following ad journment sine die of that173 regular session. A resolution objecting to such intended adopt ion may be introduced in174 either house of the General Assembly after the fifteenth day but before the thirtieth day of175 the session in which occurs the notification of intent not to withdraw a rule or part thereof. 176 In the event the resolution is adopted by the house of the General Assembly in which the177 resolution was introdu ced, it shall be immediately transmitted to the other house of the178 General Assembly. It shall be the duty of the presiding officer of the other house to have179 that house, within five days after receipt of the resolution, c onsider the resolution for180 purposes of objecting to the intended adoption of the rule or p art thereof. Upon such181 resolution being adopted by two-thirds of the vote of each house of the General Assembly,182 the rule or part thereof objected to in that resolution shall be disapproved and not adopted183 by the department. If the resolution is adopted by a majority but by less than two-thirds of184 the vote of each such house, the resolution shall be submitted to the Governor for his or her185 approval or veto. In the event of a veto, or if no resolution is introduced objecting to the186 rule, or if the resolution introduced is not approved by at least a majority of the vote of each187 such house, the rule shall automatically become adopted the day following adjournment188 sine die of that regular session. In the event of the Governor's approval of the resolution,189 the rule shall be disapproved and not adopted by the department.190 (d) Any rule or part thereof which is objected to by only one committee under191 subsection (b) of this Code section and which is adopted by the department may be192 considered by the house of the General Assembly whose committee objected to its adoption193 by the introduction of a resolution for the purpose of overriding the rule at any time within194 the first 30 days of the next regular session of the General Assembly. It shall be the duty195 of the department in adopting a proposed rule over such objecti on to notify the196 chairpersons of the Senate Health and Human Services Committee and the House197 Committee on Health and Human Services within ten days after the adoption of the rule. 198 - 8 - 26 LC 52 1109S In the event the resolution is adopted by such house of the General Assembly, it shall be199 immediately transmitted to the other house of the General Assembly. It shall be the duty200 of the presiding officer of the other house of the General Asse mbly to have such house,201 within five days after the receipt of the resolution, consider the resolution for the purpose202 of overriding the rule. In the event the resolution is adopted by two-thirds of the votes of203 each house of the General Assembly, the rule shall be void on the day after the adoption204 of the resolution by the second house of the General Assembly. In the event the resolution205 is ratified by a majority but by less than two-thirds of the vo tes of either house, the206 resolution shall be submitted to the Governor for his or her approval or veto. In the event207 of a veto, the rule shall remain in effect. In the event of the Governor's approval, the rule208 shall be void on the day after the date of approval.209 (e) Except for emergency rules, no rule or part thereof adopte d by the department after210 July 1, 2026, shall be valid unless adopted in compliance with subsections (b), (c), and (d)211 of this Code section and subsection (a) of Code Section 50-13-4.212 (f) Emergency rules shall not be subject to the requirements of subsection (b), (c), or (d)213 of this Code section but shall be subject to the requirements o f subsection (b) of Code214 Section 50-13-4. Upon the first expiration of any department emergency rules, when those215 emergency rules are intended to cover matters which had been de alt with by the216 department's nonemergency rules but such nonemergency rules have been objected to by217 both legislative committees under this Code section, the emergency rules concerning those218 matters may not again be adopted except for one 120 day period. No emergency rule or219 part thereof which is adopted by the department shall be valid unless adopted in220 compliance with this subsection.221 (g) Any proceeding to contest any rule on the ground of noncom pliance with this Code222 section must be commenced within two years from the effective date of the rule.223 (h) As used in this Code section, the term 'rules' means rules and regulations.224 - 9 - 26 LC 52 1109S (i) The state health plan or the rules establishing considerat ions, standards, or similar225 criteria for the grant or denial of a certificate of need pursu ant to Code Section 31-6-43226 shall not apply to any application for a certificate of need as to which, prior to the effective227 date of such plan or rules, respectively, the evidence has been closed following a full228 evidentiary hearing before a hearing officer.229 ARTICLE 3230 31-6-40.231 (a) On and after July 1, 2026, a ny new institutional health se rvice shall be required to232 obtain a certificate of need pursuant to this chapter. New ins titutional health services233 include:234 (1) The construction, development, or other establishment of a new, expanded, or235 relocated skilled nursing facility, except as otherwise provided in Code Section 31-6-52;236 (2) Any increase in the bed capacity of a skilled nursing facility; and237 (3) Clinical health services which are offered in or through a skilled nursing facility,238 which were not offered on a regular basis in or through such sk illed nursing facility239 within the 12 month period prior to the time such services would be offered.240 (b) Any person proposing to develop or offer a new institution al health service shall,241 before commencing such activity, submit a letter of intent and an application to the242 department and obtain a certificate of need in the manner provided in this chapter unless243 such activity is excluded from the scope of this chapter.244 (c) Any person that had a va lid exemption granted or approved by the former Health245 Planning Agency prior to July 1, 2008, or the department prior to July 1, 2026, shall not246 be required to obtain a certificate of need in order to continu e to offer those previously247 offered services.248 - 10 - 26 LC 52 1109S (d) Any pending application with the department as of the day prior to the effective date249 of this Act that relates to a facility or services other than a skilled nursing facility shall be250 deemed withdrawn by operation of law as of the effective date of this Act.251 31-6-41.252 (a) Any person who acquires a skilled nursing facility by stock or asset purchase, merger,253 consolidation, or other lawful means shall notify the departmen t of such acquisition, the254 date thereof, and the name and address of the acquiring person. Such notification shall be255 made in writing to the department within 45 days following the acquisition and the256 acquiring person may be fined by the department in the amount o f $500.00 for each day257 that such notification is late. Such fine shall be paid into the state treasury.258 (b) The department may limit the time periods during which it will accept applications for259 skilled nursing facilities to only such times after the department has determined there is an260 unmet need for such facilities. The department shall make a determination as to whether261 or not there is an unmet need for such facility at least every six months and shall notify262 those requesting such notification of that determination.263 (c) The department may require that any applicant for a certificate of need agree to provide264 a specified amount of clinical health services to indigent pati ents as a condition for the265 grant of a certificate of need. A grantee or successor in interest of a certificate of need or266 an authorization to operate under this chapter which violates such an agreement or violates267 any conditions imposed by the department relating to such services, whether made before268 or after July 1, 2008, shall be liable to the department for a monetary penalty in the amount269 of the difference between the amount of services so agreed to be provided and the amount270 actually provided and may be subject to revocation of its certificate of need, in whole or271 in part, by the department pursuant to Code Section 31-6-48. A ny penalty so recovered272 shall be paid into the state treasury.273 - 11 - 26 LC 52 1109S (d) Penalties authorized under this Code section shall be subject to the same notices and274 hearing for the levy of fines under Code Section 31-6-48.275 31-6-42.276 (a) A certificate of need shall be valid only for the defined scope, location, cost, service277 area, and person named in an application, as it may be amended, and as such scope,278 location, service area, cost, and person are approved by the de partment, unless such279 certificate of need owned by an existing skilled nursing facility is transferred to a person280 who acquires such existing facility. In such case, the certificate of need shall be valid for281 the person who acquires such a facility and for the scope, location, cost, and service area282 approved by the department. However, in reviewing an applicati on to relocate all or a283 portion of an existing skilled nursing facility, the department may allow such facility to284 divide into two or more such facilities if the department deter mines that the proposed285 division is financially feasible and would be consistent with quality patient care.286 (b) A certificate of need shall be valid and effective for a period of 12 months after it is287 issued, or such greater period of time as may be specified by the department at the time the288 certificate of need is issued. Within the effective period after the grant of a certificate of289 need, the applicant of a proposed project shall fulfill reasona ble performance and290 scheduling requirements specified by the department, by rule, to assure reasonable progress291 toward timely completion of a project.292 (c) By rule, the department may provide for extension of the e ffective period of a293 certificate of need when an applicant, by petition, makes a goo d faith showing that the294 conditions to be specified according to subsection (b) of this Code section will be295 performed within the extended period and that the reasons for the extension are beyond the296 control of the applicant.297 - 12 - 26 LC 52 1109S 31-6-43.298 (a) The written findings of fact and decision, with respect to the department's grant or299 denial of a certificate of need, shall be based on the applicable considerations specified in300 this Code section and reasonable rules promulgated by the department interpretive thereof. 301 The department shall issue a certificate of need to each applic ant whose application is302 consistent with the following considerations and such rules deemed applicable to a project,303 except as specified in subsection (f) of Code Section 31-6-45:304 (1) The proposed new institutional health service is reasonabl y consistent with the305 relevant general goals and objectives of the state health plan;306 (2) The population residing in the area served, or to be served, by the new institutional307 health service has a need for such services;308 (3) Existing alternatives for providing services in the same s ervice area as the new309 institutional health service proposed are neither currently ava ilable, implemented,310 similarly utilized, nor capable of providing a less costly alternative, or no certificate of311 need to provide such alternative services has been issued by th e department and is312 currently valid;313 (4) The project can be adequately financed and is, in the imme diate and long term,314 financially feasible;315 (5) The effects of new skilled nursing facility service on pay ors for health services,316 including governmental payers, are not unreasonable;317 (6) The costs and methods of a proposed construction project, including the costs and318 methods of energy provision and conservation, are reasonable and adequate for quality319 healthcare;320 (7) The new institutional health service proposed is reasonably financially and physically321 accessible to the residents of the proposed service area;322 (8) The proposed new institutional health service has a positi ve relationship to the323 existing healthcare delivery system in the service area;324 - 13 - 26 LC 52 1109S (9) The proposed new institutional health service encourages more efficient utilization325 of the skilled nursing facility proposing such service;326 (10) The proposed new institutional health service provides, o r would provide, a327 substantial portion of its services to individuals not residing in its defined service area or328 the adjacent service area;329 (11) The proposed new institutional health service conducts bi omedical or behavioral330 research projects or new service development which is designed to meet a national,331 regional, or state-wide need;332 (12) The proposed new institutional health service meets the c linical needs of health333 professional training programs which request assistance;334 (13) The proposed new institutional health service fosters improvements or innovations335 in the financing or delivery of health services, promotes healthcare quality assurance or336 cost effectiveness, or fosters competition that is shown to res ult in lower patient costs337 without a loss of the quality of care;338 (14) The proposed new institutional health service meets the d epartment's minimum339 quality standards, including, but not limited to, standards rel ating to accreditation,340 minimum volumes, quality improvements, assurance practices, and utilization review341 procedures; and342 (15) The proposed new institutional health service can obtain the necessary resources,343 including healthcare personnel and management personnel.344 (b) For the purposes of the considerations contained in this C ode section and in the345 department's applicable rules, relevant data which were unavailable or omitted when the346 state health plan or rules were prepared or revised may be considered in the evaluation of347 a project.348 (c) The department shall specify in its written findings of fact and decision which of the349 considerations contained in this Code section and the department's rules are applicable to350 - 14 - 26 LC 52 1109S an application and its reasoning as to and evidentiary support for its evaluation of each such351 applicable consideration and rule.352 31-6-44.353 No applicant for a new certificate of need, a modification to an existing certificate of need,354 or a conversion of a certificate of need that has any outstanding amounts owed to the state355 including fines, penalties, fees, or other payments for noncomp liance with any356 requirements contained in Code Section 31-6-41, 31-6-50, 31-7-280, or 31-8-179.2 shall357 be eligible to receive a new certificate of need or a modification to an existing certificate358 of need unless such applicant pays such outstanding amounts to the state. Any such fines,359 penalties, fees, or other payments for noncompliance shall be subject to the same notices360 and hearing for the levy of fines under Code Section 31-6-48.361 31-6-45.362 (a) At least 25 days prior to submitting an application for a certificate of need for clinical363 health services, a person shall submit a letter of intent to the department. The department364 shall provide by rule a process for submitting letters of intent and a mechanism by which365 applications may be filed to compete with and be reviewed comparatively with proposals366 described in submitted letters of intent.367 (b) Each application for a certificate of need shall be received by the department, and the368 department shall declare the application complete for review, s hall accept and date the369 application, and shall notify the applicant of the timetable for its review. The department370 shall also notify a newspaper of general circulation in the county in which the project shall371 be developed that the application is complete for review. The department shall also notify372 the appropriate regional commission and the chief elected offic ial of the county and373 municipal governments, if any, in whose boundaries the proposed project will be located374 that the application is complete for review. If the applicatio n does not comply with the375 - 15 - 26 LC 52 1109S rules governing the preparation and submission of applications, the department shall notify376 the applicant in writing and provide a list of all deficiencies . The applicant shall be377 afforded an opportunity to correct such deficiencies, and upon such correction, the378 application shall then be declared complete for review within ten days of the correction of379 such deficiencies, and notice given to a newspaper of general circulation in the county in380 which the project shall be developed that the application has b een so declared. The381 department shall also notify the appropriate regional commissio n and the chief elected382 official of the county and municipal governments, if any, in whose boundaries the proposed383 project will be located that the application is complete for re view or when in the384 determination of the department a significant amendment is filed.385 (c) The department shall specify by rule the time within which an applicant may amend386 its application. The department may request an applicant to ma ke am endments. The387 department decision shall be made on an application as amended, if at all, by the applicant.388 (d)(1) There shall be a time limit of 120 days for review of a project, beginning on the389 day the department receives the application. The department ma y adopt rules for390 determining when it is not practicable to complete a review in 120 days and may extend391 the review period upon written notice to the applicant but only for an extended period of392 not longer than an additional 30 days. The department shall ad opt rules governing the393 submission of additional information by the applicant and for opposing an application;394 provided, however, that such rules shall provide that any party permitted to oppose an395 application shall submit a notice of opposition no later than 3 0 days of receipt by the396 department of such application.397 (2) No party may oppose an application for a certificate of need for a proposed project398 unless:399 (A) Such party offers substantially similar services as proposed within a 35 mile radius400 of the proposed project or has a service area that overlaps the applicant's proposed401 service area; or402 - 16 - 26 LC 52 1109S (B) Such party has submitted a competing application in the same batching cycle and403 is proposing to establish the same type of facility proposed or offers substantially404 similar services as proposed and has a service area that overla ps the applicant's405 proposed service area.406 (e) To allow the opportunity for comparative review of applications, the department may407 provide by rule for applications for a certificate of need to be submitted on a timetable or408 batching cycle basis no less often than two times per calendar year for each clinical health409 service. Applications for services, facilities, or expenditures for which there is no specified410 batching cycle may be filed at any time.411 (f) The department may order the joinder of an a pplication which is determined to be412 complete by the department for comparative review with one or more subsequently filed413 applications declared complete for review during the same batching cycle when:414 (1) The first and subsequent applications involve similar clinical health service projects415 in the same service area or overlapping service areas; and416 (2) The subsequent applications are filed and are declared complete for review within 30417 days of the date the first application was declared complete for review.418 Following joinder of the first application with subsequent appl ications, none of the419 subsequent applications so joined may be considered as a first application for the purposes420 of future joinder. The department shall notify the applicant to whose application a joinder421 is ordered and all other applicants previously joined to such application of the fact of each422 joinder pursuant to this subsection. In the event one or more applications have been joined423 pursuant to this subsection, the time limits for department action for all of the applicants424 shall run from the latest date that any one of the joined applications was declared complete425 for review. In the event of the consideration of one or more applications joined pursuant426 to this subsection, the department may award no certificate of need or one or more427 certificates of need to the applicant or applicants, if any, wh ich are consistent with the428 - 17 - 26 LC 52 1109S considerations contained in Code Section 31-6-43, the department's applicable rules, and429 the award of which will best satisfy the purposes of this chapter.430 (g) The department shall review the application and all written information submitted by431 the applicant in support of the application and all information submitted in opposition to432 the application to determine the extent to which the proposed project is consistent with the433 applicable considerations stated in Code Section 31-6-43 and in the department's applicable434 rules. During the course of the review, the department staff m ay request additional435 information from the applicant as deemed appropriate. Pursuant to rules adopted by the436 department, a public hearing on applications covered by those r egulations may be held437 prior to the date of the department's decision thereon. Such rules shall provide that when438 good cause has been shown, a public hearing shall be held by th e department. Any439 interested person may submit information to the department concerning an application, and440 an applicant shall be entitled to notice of and to respond to any such submission.441 (h) The department shall within 30 days of receipt of the application provide the applicant442 an opportunity to meet with the department to discuss such application and to provide the443 applicant an opportunity to submit additional information. Suc h additional information444 shall be submitted within the time limits adopted by the department. The department shall445 also provide an opportunity for any party that is permitted to oppose an application446 pursuant to paragraph (2) of subsection (d) of this Code sectio n to meet with the447 department and to provide additional information to the department. In order for any such448 opposing party to have standing to appeal an adverse decision p ursuant to Code449 Section 31-6-46, such party must attend and participate in an opposition meeting.450 (i) Unless extended by the department for an additional period of up to 30 days pursuant451 to subsection (d) of this Code section, the department shall, no later than 120 days after an452 application is determined to be complete for review, or, in the event of joined applications,453 120 days after the last application is declared complete for re view, provide written454 notification to an applicant of the department's decision to issue or to deny issuance of a455 - 18 - 26 LC 52 1109S certificate of need for the proposed project. Such notice shal l contain the department's456 written findings of fact and decision as to each applicable con sideration or rule and a457 detailed statement of the reasons and evidentiary support for issuing or denying a certificate458 of need for the action proposed by each applicant. The departm ent shall also mail such459 notification to the appropriate regional commission and the chi ef elected official of the460 county and municipal governments, if any, in whose boundaries the proposed project will461 be located. In the event such decision is to issue a certifica te of need, the certificate of462 need shall be effective on the day of the decision unless the d ecision is appealed to the463 Certificate of Need Appeal Panel in accordance with this chapte r. Within seven days of464 the decision, the department shall publish notice of its decisi on to grant or deny an465 application in the same manner as it publishes notice of the filing of an application.466 (j) Should the department fail to provide written notification of the decision within the467 time limitations set forth in this Code section, an application shall be deemed to have been468 approved as of the one hundred twenty first day following notice from the department that469 an application, or the last of any applications joined pursuant to subsection (f) of this Code470 section, is declared complete for review.471 (k) Notwithstanding other provisions of this article, when the Governor has declared a472 state of emergency in a region of the state, existing healthcar e facilities in the affected473 region may seek emergency approval from the department to offer services that may474 otherwise require a certificate of need. The department shall give special expedited475 consideration to such requests and may authorize such requests for good cause. Once the476 state of emergency has been lifted, any services offered by an affected skilled nursing477 facility under this subsection shall cease to be offered until such time as the skilled nursing478 facility that received the emergency authorization has requested and received a certificate479 of need. As used in this subsection, the term 'good cause' means that authorization of the480 request shall directly resolve a situation posing an immediate threat to the health and safety481 of the public. The department shall establish, by rule, procedures whereby requirements482 - 19 - 26 LC 52 1109S for the process of review and issuance of a certificate of need may be modified and483 expedited as a result of emergency situations.484 31-6-46.485 (a) There is recreated the Certificate of Need Appeal Panel, w hich shall be an agency486 separate and apart from the department and shall consist of a panel of independent hearing487 officers. The purpose of the appeal panel shall be to serve as a panel of independent488 hearing officers to review the department's initial decision to grant or deny a certificate of489 need application. The Certificate of Need Appeal Panel in exis tence on June 30, 2026,490 shall be reconstituted and each member of such appeal panel sha ll be reconstituted as a491 member of such reconstituted appeal panel, effective July 1, 2026.492 (b) The appeal panel shall be composed of five members appointed by the Governor for493 a term of up to four years each. The Governor shall appoint to the appeal panel attorneys494 who practice law in this state and who are familiar with the healthcare industry but who do495 not have a financial interest in or represent or have any compe nsation arrangement with496 any skilled nursing facility. Each member of the appeal panel shall be an active member497 of the State Bar of Georgia in good standing, and each attorney shall have maintained such498 active status for the five years immediately preceding such per son's appointment. The499 Governor shall name from among such members a chairperson and a vice chairperson of500 the appeal panel. The vice chairperson shall have the same authority as the chairperson;501 provided, however, that the vice chairperson shall not exercise such authority unless502 expressly delegated by the chairperson or in the event the chai rperson becomes503 incapacitated, as determined by the Governor. Vacancies on the appeal panel caused by504 resignation, death, or any other cause shall be filled for the unexpired term in the same505 manner as the original appointment. No person required to register with the Secretary of506 State as a lobbyist or registered agent shall be eligible for appointment by the Governor to507 the appeal panel.508 - 20 - 26 LC 52 1109S (c) The appeal panel shall promulgate reasonable rules for its operation and rules of509 procedure for the conduct of initial administrative appeal hearings held by the appointed510 hearing officers, including an appropriate fee schedule for filing such appeals. Members511 of the appeal panel shall serve as hearing officers for appeals that are assigned to them on512 a random basis by the chairperson of the appeal panel. The members of the appeal panel513 shall receive no salary but shall be reimbursed for their expenses in attending meetings and514 for transportation costs as authorized by Code Section 45-7-21, which provides for515 compensation and allowances of certain state officials; provide d, however, that the516 chairperson and vice chairperson of the appeal panel shall also be compensated for their517 services rendered to the appeal panel outside of attendance at an appeal panel meeting, such518 as for time spent assigning hearing officers, the amount of whi ch compensation shall be519 determined according to regulations of the Department of Administrative Services. Appeal520 panel members shall receive compensation for the administration of the cases assigned to521 them, including prehearing, hearing, and posthearing work, in an amount determined to be522 appropriate and reasonable by the Department of Administrative Services. Such523 compensation to the members of the appeal panel shall be made b y the Department of524 Administrative Services.525 (d) Any party that is permitted to oppose an application pursu ant to paragraph (2) of526 subsection (d) of Code Section 31-6-45 that has notified the department prior to its decision527 that such party is opposed to the application before the department shall have the right to528 an initial administrative appeal hearing before an appeal panel hearing officer or to529 intervene in such hearing. Such request for hearing or intervention shall be filed with the530 chairperson of the appeal panel within 30 days of the date of the decision made pursuant531 to Code Section 31-6-45. In the event an appeal is filed by a party that is permitted to532 oppose an application pursuant to paragraph (2) of subsection (d) of Code Section 31-6-45,533 the appeal shall be accompanied by payment of such fee as is es tablished by the appeal534 panel. In the event an appeal is requested, the chairperson of the appeal panel shall appoint535 - 21 - 26 LC 52 1109S a hearing officer for each such hearing within 30 days after the date the appeal is received. 536 Within 14 days after the appointment of the hearing officer, su ch hearing officer shall537 confer with the parties and set the date or dates for the hearing, provided that no hearing538 shall be scheduled less than 60 days nor more than 120 days after the filing of the request539 for a hearing, unless the applicant consents or, in the case of competing applicants, all540 applicants consent to an extension of this time period to a spe cified date. Unless the541 applicant consents or, in the case of competing applicants, all applicants consent to an542 extension of said 120 day period, any hearing officer who regularly fails to commence a543 hearing within the required time period shall not be eligible f or continued service as a544 hearing officer for the purposes of this Code section. The hea ring officer shall have the545 authority to dispose of all motions made by any party before th e issuance of the hearing546 officer's decision and shall make such rulings as may be requir ed for the conduct of the547 hearing.548 (e) In fulfilling the functions and duties of this chapter, the hearing officer shall act, and549 the hearing shall be conducted as a full evidentiary hearing, in accordance with Chapter 13550 of Title 50, the 'Georgia Administrative Procedure Act,' relating to contested cases, except551 as otherwise specified in this Code section. Subject to the pr ovisions of Article 4 of552 Chapter 18 of Title 50, all files, working papers, studies, not es, and other writings or553 information used by the department in making its decision shall be public records and554 available to the parties, and the hearing officer may permit ea ch party to exercise such555 reasonable rights of prehearing discovery of such information used by the parties as will556 expedite the hearing.557 (f) In addition to evidence submitted to the department, a party may present any additional558 relevant evidence to the appeal panel hearing officer reviewing the decision of the559 department if the evidence was not reasonably available to the party presenting the560 evidence at the time of the department's review. The burden of proof as to whether the561 evidence was reasonably available shall be on the party attempt ing to introduce the new562 - 22 - 26 LC 52 1109S evidence. The issue for the decision by the hearing officer sh all be whether, and the563 hearing officer shall order the issuance of a certificate of ne ed if, in the hearing officer's564 judgment, the application is consistent with the considerations as set forth in Code565 Section 31-6-43 and the department's rules, as the hearing offi cer deems such566 considerations and rules applicable to the review of the projec t . T h e a p p e a l h e a r i n g567 conducted by the appeal panel hearing officer shall be a de novo review of the decision of568 the department. The hearing officer shall also consider:569 (1) Whether the department committed prejudicial procedural error in its consideration570 of the application;571 (2) Whether the appeal lacks substantial justification; and572 (3) Whether such appeal was undertaken primarily for the purpo se of delay or573 harassment.574 The burden of proof shall be on the appellant. Appellants or applicants shall proceed first575 with their cases before the hearing officer in the order determined by the hearing officer,576 and the department, if a party, shall proceed last. In the event of a consolidated hearing on577 applications which were joined for comparative review pursuant to subsection (f) of Code578 Section 31-6-45, the hearing officer shall have the same powers s p e c i f i e d f o r t h e579 department in subsection (f) of Code Section 31-6-45 to order the issuance of no certificate580 of need or one or more certificates of need.581 (g) All evidence shall be presented at the initial administrative appeal hearing conducted582 by the appointed hearing officer. A party or intervenor may present any relevant evidence583 on all issues raised by the hearing officer or any party to the hearing or revealed during584 discovery and shall not be limited to evidence or information presented to the department585 prior to its decision, except that an applicant may not present a new need study or analysis586 responsive to the general need consideration or service-specific need formula as provided587 in the applicable rules that is substantially different from an y such study or analysis588 submitted to the department prior to its decision and that coul d have reasonably been589 - 23 - 26 LC 52 1109S available for submission. The hearing officer may consider the latest data available,590 including updates of studies previously submitted, in deciding whether an application is591 consistent with the applicable considerations or rules. The hearing officer shall consider592 the applicable considerations and rules in effect on the date the appeal is filed, even if the593 provisions of those considerations or rules were changed after the department's decision. 594 The hearing officer may remand a matter to the department if th e hearing officer595 determines that it would be beneficial for the department to consider new data, studies, or596 analyses that were not available before the decision or changes to the provisions of the597 applicable considerations or rules made after the department's decision. The hearing officer598 shall establish the time deadlines for completion of the remand and shall retain jurisdiction599 of the matter throughout the completion of the remand.600 (h) After the issuance of a decision by the department pursuant to Code Section 31-6-43,601 no party to an appeal hearing, nor any person on behalf of such party, including the602 department, shall make any ex parte contact with the appeal panel hearing officer appointed603 to conduct the appeal hearing or any other member of the appeal panel in regard to a604 decision under appeal.605 (i) Within 30 days after the conclusion of the hearing, the he aring officer shall make606 written findings of fact and conclusions of law as to each consideration as set forth in Code607 Section 31-6-43 and the department's rules, including a detailed statement of the reasons608 for the decision of the hearing officer. If any party has alle ged that an appeal lacks609 substantial justification or was undertaken primarily for the purpose of delay or harassment,610 the decision of the hearing officer shall make findings of fact addressing the merits of the611 allegation. The hearing officer shall file such decision with the chairperson of the appeal612 panel who shall serve such decision upon all parties, and shall transmit the administrative613 record to the department.614 (j) The decision of the appeal panel hearing officer shall constitute the final decision of the615 department. Such final decision shall be the final department decision for purposes of616 - 24 - 26 LC 52 1109S Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.' The appeals process617 provided by this Code section shall be the administrative remedy only for decisions made618 by the department pursuant to Code Section 31-6-45 which involve the approval or denial619 of applications for certificates of need.620 (k) All matters of the appeal panel that relate to facilities other than skilled nursing621 facilities that are pending as of the day prior to the effectiv e date of this Act shall be622 dismissed without prejudice by operation of law as of the effective date of this Act.623 31-6-47.624 (a) Any party to the initial administrative appeal hearing con ducted by the appointed625 appeal panel hearing officer, excluding the department, may see k judicial review of the626 final decision in accordance with the method set forth in Chapt er 13 of Title 50, the627 'Georgia Administrative Procedure Act,' except as otherwise modified by this Code section;628 provided, however, that in conducting such review, the court ma y reverse or modify the629 final decision only if substantial rights of the appellant have been prejudiced because the630 procedures followed by the department or the hearing officer or the administrative findings,631 inferences, and conclusions contained in the final decision are:632 (1) In violation of constitutional or statutory provisions;633 (2) In excess of the statutory authority of the department;634 (3) Made upon unlawful procedures;635 (4) Affected by other error of law;636 (5) Not supported by substantial evidence, which shall mean th at the record does not637 contain such relevant evidence as a reasonable mind might accept as adequate to support638 such findings, inferences, conclusions, or decisions, which such evidentiary standard shall639 be in excess of the 'any evidence' standard contained in other statutory provisions; or640 (6) Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted641 exercise of discretion.642 - 25 - 26 LC 52 1109S (b) In the event a party seeks judicial review, the proceeding s for such review shall be643 governed by Chapter 3 of Title 5 except as provided otherwise in this Code section. If a644 party seeks judicial review, the department shall, within 30 days after being served with a645 copy of the petition for review filed in the superior court, tr ansmit certified copies of all646 documents and papers in its file together with a transcript of the testimony taken and its647 findings of fact and decision to the clerk of the superior court to which the case has been648 appealed. The case so appealed may then be brought by either party upon ten days' written649 notice to the other before the superior court for a hearing upon such record, subject to an650 assignment of the case for hearing by the court; provided, however, that, if the court does651 not hear the case within 120 days of the date of docketing in the superior court, the decision652 of the department shall be considered affirmed by operation of law unless a hearing653 originally scheduled to be heard within the 120 days has been continued to a date certain654 by order of the court. In the event a hearing is held later th an 90 days after the date of655 docketing in the superior court because same has been continued to a date certain by order656 of the court, the decision of the department shall be considere d affirmed by operation of657 law if no order of the court disposing of the issues on appeal has been entered within 30658 days after the date of the continued hearing. If a case is hea rd within 120 days from the659 date of docketing in the superior court, the decision of the department shall be considered660 affirmed by operation of law if no order of the court disposing of the issues on appeal has661 been entered within 30 days of the date of the hearing.662 (c) A party responding to an app eal to the superior court shal l be entitled to reasonable663 attorney's fees and costs if such party is the prevailing party of such appeal as decided by664 final order; provided, however, that the department shall not be required to pay attorney's665 fees or costs. This subsection shall not apply to the portion of attorney's fees accrued on666 behalf of a party responding to or bringing a challenge to the department's authority to667 enact a rule or regulation or the department's jurisdiction or another challenge that could668 not have been raised in the administrative proceeding.669 - 26 - 26 LC 52 1109S 31-6-48.670 (a) The department may revoke a certificate of need, in whole or in part, after notice to the671 holder of the certificate and a fair hearing pursuant to Chapter 13 of Title 50, the 'Georgia672 Administrative Procedure Act,' for the following reasons:673 (1) Failure to comply with the provisions of Code Section 31-6-42;674 (2) The intentional provision of false information to the department by an applicant in675 that applicant's application;676 (3) Repeated failure to pay any fines or moneys due to the department;677 (4) Failure to maintain minimum quality of care standards that may be established by the678 department; or679 (5) Failure to participate as a provider of medical assistance for Medicaid purposes680 pursuant to Code Section 31-6-50 or any other applicable Code section.681 The department may not, however, revoke a certificate of need if the applicant changes the682 defined location of the project within the same county to a loc ation less than three miles683 from the location specified in the certificate of need for financial reasons or other reasons684 beyond its control, including, but not limited to, failure to o btain any required approval685 from zoning or other governmental agencies or entities, provide d that such change in686 location is otherwise consistent with the considerations and rules applied in the evaluation687 of the project.688 (b) The department may revoke a certificate of need, in whole or in part, after notice to the689 holder of the certificate and a fair hearing pursuant to Chapter 13 of Title 50, the 'Georgia690 Administrative Procedure Act,' if the services or units of services for which the certificate691 of need was issued are not implemented in a timely manner, as e stablished by the692 department in its rules.693 (c) Any skilled nursing facility offering a new institutional health service without having694 obtained a certificate of need and which has not been previousl y licensed as a skilled695 nursing facility shall be denied a license to operate.696 - 27 - 26 LC 52 1109S (d) In the event that a new institutional health service is knowingly offered or developed697 without having obtained a certificate of need as required by this chapter, or the certificate698 of need for such service is revoked according to the provisions of this Code section, a699 facility or applicant may be fined an amount of $5,000.00 per d ay up to 30 days,700 $10,000.00 per day from 31 days through 60 days, and $25,000.00 per day after 60 days701 for each day that the violation of this chapter has existed and knowingly and willingly702 continues; provided, however, that the expenditure or commitmen t of or incurring an703 obligation for the expenditure of funds to take or perform actions not subject to this chapter704 or to acquire, develop, or prepare a skilled nursing facility s ite for which a certificate of705 need application is denied shall not be a violation of this chapter and shall not be subject706 to such a fine. The commissioner shall determine, after notice and a hearing, whether the707 fines provided in this Code section shall be levied.708 (e) In addition, for purposes of this Code section, the State of Georgia, acting by and709 through the department, or any other interested person, shall have standing in any court of710 competent jurisdiction to maintain an action for injunctive relief to enforce the provisions711 of this chapter.712 (f) The department shall have the authority to make public or private investigations or713 examinations inside or outside of this state to determine whether all provisions of this Code714 section or any other law, rule, regulation, or formal order relating to the provisions of Code715 Section 31-6-40 has been violated. Such investigations may be initiated at any time in the716 discretion of the department and may continue during the pendency of any action initiated717 by the department pursuant to subsection (a) of this Code secti on. For the purpose of718 conducting any investigation or inspection pursuant to this subsection, the department shall719 have the authority, upon providing reasonable notice, to requir e the production of any720 books, records, papers, or other information related to any certificate of need issue.721 - 28 - 26 LC 52 1109S 31-6-49.722 (a) A skilled nursing facility which has a certificate of need or is otherwise authorized to723 operate pursuant to this chapter shall have such certificate of need or authority to operate724 automatically revoked by operation of law without any action by the department when that725 facility's permit to operate pursuant to Code Section 31-7-4 is finally revoked by order of726 the department. For purposes of this subsection, the date of such final revocation shall be727 as follows:728 (1) When there is no appeal of the order pursuant to Chapter 5 of this title, the one729 hundred and eightieth day after the date upon which expires the time for appealing the730 revocation order without such an appeal being filed; or731 (2) When there is an appeal of the order pursuant to Chapter 5 of this title, the date upon732 which expires the time to appeal the last administrative or jud icial order affirming or733 approving the revocation or revocation order without such appeal being filed.734 (b) The services which had been authorized to be offered by a skilled nursing facility for735 which a certificate of need has been revoked pursuant to subsection (a) of this Code section736 may continue to be offered in the service area in which that facility was located under such737 conditions as specified by the department notwithstanding that some or all of such services738 could not otherwise be offered as new institutional health services.739 31-6-50.740 (a) The department may require that any applicant for a certif icate of need agree to741 participate as a provider of medical assistance for Medicaid purposes pursuant to Article 7742 of Chapter 4 of Title 49.743 (b) Any proposed or existing skilled nursing facility which obtains a certificate of need on744 or after July 1, 2026, based in part upon assurances that it will participate as a provider of745 medical assistance, as defined in paragraph (6) of Code Section 49-4-141, and which746 terminates its participation as a provider of medical assistance or violates any conditions747 - 29 - 26 LC 52 1109S imposed by the department relating to such participation, shall be subject to a monetary748 penalty in the amount of the difference between the Medicaid covered services which the749 facility agreed to provide in its certificate of need applicati on and the amount actually750 provided and may be subject to revocation of its certificate of need by the department751 pursuant to Code Section 31-6-48; provided, however, that this Code section shall not752 apply if:753 (1) Such facility's participation as a provider of medical assistance is terminated by the754 state or federal government; or755 (2) Such facility establishes good cause for terminating its participation as a provider of756 medical assistance. As used in this Code section, the term 'good cause' means:757 (A) Changes in the adequacy of medical assistance payments, as defined in758 paragraph (5) of Code Section 49-4-141, provided that at least 10 percent of the759 facility's utilization during the preceding 12 month period was attributable to services760 to recipients of medical assistance, as defined in paragraph (7 ) of Code761 Section 49-4-141. Medical assistance payments to a facility sh all be presumed762 adequate unless the revenues received by the facility from all sources are less than the763 total costs set forth in the cost report for the preceding full 12 month period filed by764 such facility pursuant to the state plan as defined in paragrap h (8) of Code765 Section 49-4-141 which are allowed under the state plan for purposes of determining766 such facility's reimbursement rate for medical assistance and the aggregate amount of767 such facility's medical assistance payments (including any amou nts received by the768 facility from recipients of medical assistance) during the preceding full 12 month cost769 reporting period is less than 85 percent of such facility's Medicaid costs for such period. 770 Medicaid costs shall be determined by multiplying the allowable costs set forth in the771 cost report, less any audit adjustments, by the percentage of t he facility's utilization772 during the cost reporting period which was attributable to reci pients of medical773 assistance;774 - 30 - 26 LC 52 1109S (B) Changes in the overall ability of the facility to cover its costs if such changes are775 of such a degree as to seriously threaten the continued viability of the facility; or776 (C) Changes in the state plan, statutes, or rules and regulations governing providers of777 medical assistance which impose substantial new obligations upon the facility which778 are not reimbursed by Medicaid and which adversely affect the financial viability of the779 facility in a substantial manner.780 (c) A facility seeking to terminate its enrollment as a provider of medical assistance shall781 submit a written request to the department documenting good cause for termination. The782 department shall grant or deny the facility's request within 30 days. If the department783 denies the facility's request, the facility shall be entitled to a hearing conducted in the same784 manner as an evidentiary hearing conducted by the department pursuant to the provisions785 of Code Section 49-4-153 within 30 days of the department's decision.786 (d) The imposition of the monetary penalty provided in this Code section shall commence787 upon the date that said facility has terminated its participati on as a provider of medical788 assistance, as determined by the commissioner. The monetary penalty shall be levied and789 collected by the department on an annual basis for every year in which the facility fails to790 participate as a provider of medical assistance. Penalties aut horized under this Code791 section shall be subject to the same notices and hearings as provided for levy of fines under792 Code Section 31-6-48.793 31-6-51.794 The department shall prepare and submit an annual report to the board and to the Senate795 Health and Human Services Committee and the House Committee on Health and Human796 Services about its operations and decisions for the preceding 1 2 month period, not later797 than 30 days prior to each convening of the General Assembly in regular session. Either798 committee may request any additional reports or information, including decisions, from the799 department at any time, including a period in which the General Assembly is not in regular800 - 31 - 26 LC 52 1109S session. The annual report shall include information and updates relating to the state health801 plan and the certificate of need program and an annual analysis of proactive and802 prospective approaches to need methodologies and access to skil led nursing facility803 services. The annual report shall include information for Geor gia's congressional804 delegation which highlights issues regarding federal laws and r egulations influencing805 Medicaid and Medicare, insurance and related tax laws, and long-term healthcare.806 31-6-52.807 (a) Notwithstanding the other provisions of this chapter, this chapter shall not apply to:808 (1) Institutions operated exclusively by the federal government or by any of its agencies;809 (2) Religious, nonmedical hea lthcare institutions as defined i n 42 U.S.C.810 Section 1395x(ss)(1), listed and certified by a national accrediting organization;811 (3) Site acquisitions for skilled nursing facilities or preparation or development costs for812 such sites prior to the decision to file a certificate of need application;813 (4) Expenditures related to adequate preparation and development of an application for814 a certificate of need;815 (5) The commitment of funds conditioned upon the obtaining of a certificate of need;816 (6) Expenditures for the restructuring or acquisition of existing skilled nursing facilities817 by stock or asset purchase, merger, consolidation, or other lawful means;818 (7) An expenditure for the minor or major repair of a skilled nursing facility;819 (8) Capital expenditures otherwise covered by this chapter required solely to eliminate820 or prevent safety hazards as defined by federal, state, or loca l fire, building,821 environmental, occupational health, or life safety codes or reg ulations, to comply with822 licensing requirements of the department, or to comply with accreditation standards of823 a nationally recognized healthcare accreditation body;824 (9) Cost overruns whose percentage of the cost of a project is equal to or less than the825 cumulative annual rate of increase in the composite construction index, published by the826 - 32 - 26 LC 52 1109S United States Bureau of the Census of the Department of Commerce, calculated from the827 date of approval of the project;828 (10) Transfers from one skilled nursing facility to another such facility of major medical829 equipment previously approved under or exempted from certificat e of need review,830 except where such transfer results in the institution of a new clinical health service for831 which a certificate of need is required in the facility acquiring such equipment, provided832 that such transfers are recorded at net book value of the medical equipment as recorded833 on the books of the transferring facility;834 (11) New institutional health services provided by or on behal f of skilled nursing835 facilities in circumstances defined by the department pursuant to federal law;836 (12) Expenditures for nonclinical projects, including parking lots, parking decks, and837 other parking facilities; computer systems, software, and other information technology;838 administrative office space; conference rooms; education facili ties; lobbies; common839 spaces; clinical staff lounges and sleep areas; waiting rooms; bathrooms; cafeterias;840 hallways; engineering facilities; mechanical systems; roofs; gr ounds; signage; family841 meeting or lounge areas; other nonclinical physical plant renovations or upgrades that do842 not result in new or expanded clinical health services;843 (13) Facilities operated by, on behalf of, or under contract w ith the Department of844 Corrections or the Department of Juvenile Justice for the sole and exclusive purpose of845 providing healthcare services in a secure environment to prison ers within a penal846 institution, penitentiary, prison, detention center, or other secure correctional institution,847 including correctional institutions operated by private entities in this state which house848 inmates under the Department of Corrections or the Department of Juvenile Justice;849 (14) The relocation of any skilled nursing facility within the same county; or 850 (15) The renovation, remodeling, refurbishment, or upgrading o f a skilled nursing851 facility, so long as the project does not result in the offerin g of any new or expanded852 clinical health services.853 - 33 - 26 LC 52 1109S (b) By rule, the department shall establish a procedure for expediting or waiving reviews854 of certain projects, the nonreview of which it deems compatible with the purposes of this855 chapter, in addition to expenditures exempted from review by this Code section.856 31-6-53.857 The review and appeal considerations and procedures set forth in Code Sections 31-6-43858 through 31-6-46, respectively, shall apply to and govern the review of capital expenditures859 under the Section 1122 program of the federal Social Security Act of 1935, as amended,860 including, but not limited to, any application for approval und er Section 1122 which is861 under consideration by the department or on appeal before the Certificate of Need Appeal862 Panel."863 PART II864 Conforming changes865 SECTION 2-1.866 Title 16 of the Official Code of Georgia Annotated, relating to crimes and offenses, is867 amended by revising paragraph (8) of Code Section 16-11-62, rel ating to eavesdropping,868 surveillance, or intercepting communication which invades privacy of another and divulging869 private message, as follows:870 "(8) Any person to intentionally and in a clandestine manner pl ace, or direct someone871 else to place, a global positi oning system monitoring device, o r any other electronic872 monitoring device, on a motor vehi cle owned or leased by anothe r person without the873 consent of such person when such person has a protective order pursuant to Code874 Section 17-17-16, 19-13-4, or 19-13A-4, or a protective order from another jurisdiction,875 against the person who places, or directs another to place, the global positioning system876 monitoring device or other electronic device. Nothing in this paragraph shall be877 - 34 - 26 LC 52 1109S construed to limit electronic monitoring as provided in Code Se ctions 31-7-12, o r878 31-7-12.1, and 31-6-2; or "879 SECTION 2-2.880 Title 31 of the Official Code of Georgia Annotated, relating to health, is amended in881 Chapter 2, relating to Department of Community Health, by revis ing paragraph (12) of882 subsection (d) of Code Section 31-2-4, relating to powers, duti es, functions, and883 responsibilities, divisions, directors, and contracts for health benefits, as follows:884 "(12) Shall request federal approval for and facilitate the app lication of certificates of885 need for licensure of facilities capable of providing long-term care services, with886 Medicaid as the primary funding source, to inmates who are eligible for such services and887 funding upon his or her release from a public institution, as such term is defined in Code888 Section 49-4-31."889 SECTION 2-3.890 Said title is further amended in said chapter by replacing "Cod e Section 31-6-21.1" with891 "Code Section 31-6-21" wherever the former term occurs in:892 (1) Code Section 31-2-5, relating to transfer of personnel, fu nctions, rights, duties,893 regulations, agreements, and property; and894 (2) Code Section 31-2-7, relating to rules and regulations, va riances, waivers, and895 exemptions.896 SECTION 2-4.897 Said title is further amended in Chapter 7, relating to regulation and construction of hospitals898 and other health care facilities, by revising paragraph (4) of and adding a new paragraph to899 Code Section 31-7-1, relating to definitions, to read as follows:900 "(4) 'Institution' means:901 - 35 - 26 LC 52 1109S (A) Any building, facility, or place in which are provided two or more beds and other902 facilities and services that are used for persons received for examination, diagnosis,903 treatment, surgery, maternity care, nursing care, assisted living care, or personal care904 for periods continuing for 24 hours or longer and which is classified by the department,905 as provided for in this chapter, as either a hospital, nursing home, assisted living906 community, intermediate care facility, or personal care home;907 (B) Any health facility wherein abortion procedures under subsections (b) and (c) of908 Code Section 16-12-141 are performed or are to be performed;909 (C) Any building or facility, not under the operation or control of a hospital, which is910 primarily devoted to the provision of surgical treatment to pat ients not requiring911 hospitalization and which is classified by the department as an ambulatory surgical912 treatment center;913 (D) Any fixed or mobile specimen collection center or health t esting facility where914 specimens are taken from the human body for delivery to and examination in a licensed915 clinical laboratory or where certain measurements such as heigh t and weight916 determination, limited audio and visual tests, and electrocardi ograms are made,917 excluding public health services operated by the state, its counties, or municipalities;918 (E) Any building or facility where human births occur on a regular and ongoing basis919 and which is classified by the department as a birthing center;920 (F) Any building or facility whic h is devoted to the provision of treatment and921 rehabilitative care for periods continuing for 24 hours or longer for persons who have922 traumatic brain injury, as defined in Code Section 37-3-1; or923 (G) Any freestanding imaging center where magnetic resonance imaging, computed924 tomography (CT) scanning, positron emission tomography (PET) sc anning, positron925 emission tomography/computed tomography, and other advanced imaging services as926 defined by the department by rule, but not including X-rays, fluoroscopy, or ultrasound927 services, are conducted in a location or setting not affiliated or attached to a hospital or928 - 36 - 26 LC 52 1109S in the offices of an individual private physician or single group practice of physicians929 and conducted exclusively for patients of that physician or group practice.930 (4.1) 'Intermediate care facility' means an institution which provides, on a regular basis,931 health related care and services to individuals who do not require the degree of care and932 treatment which a hospital or skilled nursing facility is desig ned to provide but who,933 because of their mental or physical condition, require health r elated care and services934 beyond the provision of room and board."935 SECTION 2-5.936 Said title is further amended in said chapter by revising subse ction (a) of Code937 Section 31-7-3, relating to requirements for permits to operate institutions, as follows:938 "(a) Any person or persons responsible for the operation of any institution skilled nursing939 facility, or who may hereafter propose to establish and operate an inst itution a skilled940 nursing facility and to provide specified clinical services, shall submit an application to the941 department for a permit to operate the institution skilled nursing facility and provide such942 services, such application to be made on forms prescribed by th e department. No943 institution skilled nursing facility shall be operated in this state without such a permit,944 which shall be displayed in a conspicuous place on the premises. No clinical services shall945 be provided by an institution a skilled nursing facility except as approved by the946 department in accordance with the rules and regulations establi shed pursuant to Code947 Section 31-7-2.1. Failure or refusal to file an application fo r a permit shall constitute a948 violation of this chapter and shall be dealt with as provided for in Article 1 of Chapter 5 of949 this title. Following inspection and classification of the institution skilled nursing facility950 for which a permit is applied for, the department may issue or refuse to issue a permit or951 a provisional permit. Permits issued shall remain in force and effect until revoked or952 suspended; provisional permits issued shall remain in force and effect for such limited953 period of time as may be specified by the department. Upon con clusion of the Atlantic954 - 37 - 26 LC 52 1109S Cardiovascular Patient Outcomes Research Team (C-PORT) Study, the department shall955 consider and analyze the data and conclusions of the study and promulgate rules pursuant956 to Code Section 31-7-2.1 to regulate the quality of care for th erapeutic cardiac957 catheterization. All hospitals that participated in the study and are exempt from obtaining958 a certificate of need based on paragraph (22) of subsection (a) of Code Section 31-6-47959 shall apply for a permit to continue providing therapeutic cardiac catheterization services960 once the department promulgates the rules required by this Code section."961 SECTION 2-6.962 Said title is further amended in said chapter by revising parag raph (24) of Code963 Section 31-7-75, relating to functions and powers, as follows:964 "(24) To provide management, consulting, and operating services including, but not965 limited to, administrative, operational, personnel, and mainten ance services to another966 hospital authority, hospital, health care facility, as said term is defined in Chapter 6 of this967 title, healthcare facility, person, firm, corporation, or any other entity or any group or968 groups of the foregoing; to enter into contracts alone or in co njunction with others to969 provide such services without regard to the location of the parties to such transactions;970 to receive management, consulting, and operating services including, but not limited to,971 administrative, operational, personnel, and maintenance service s from another such972 hospital authority, hospital, health care facility, person, fir m, corporation, or any other973 entity or any group or groups of the foregoing; and to enter in to contracts alone or in974 conjunction with others to receive such services without regard to the location of the975 parties to such transactions;"976 - 38 - 26 LC 52 1109S SECTION 2-7.977 Said title is further amended in said chapter by revising parag raph (1) of subsection (e) of978 Code Section 31-7-94.1, relating to rural hospital organization assistance, legislative979 findings, grant eligibility, and rules and regulations, as follows:980 "(1) Infrastructure development, including, without being limited to, health information981 technology, facility renovation, or equipment acquisition; prov ided, however, that the982 amount granted to any qualified hospital may not exceed the expenditure thresholds that983 would constitute a new institutional health service requiring a certificate of need under984 Chapter 6 of this title and the grant award may be conditioned upon obtaining local985 matching funds;"986 SECTION 2-8.987 Said title is further amended in said chapter by revising subse ction (i) of Code988 Section 31-7-116, relating to issuance of bonds and bond anticipation notes, obligations of989 authority, and limitations and conditions, as follows:990 "(i) No bonds or bond anticipation notes except refunding bonds shall be issued by an991 authority under this article unless its board of directors shall adopt a resolution finding that992 the project for which such bonds or notes are to be issued will promote the objectives stated993 in subsection (b) of Code Section 31-7-111 and will increase or maintain employment in994 the territorial area of such authority. Nothing contained in t his Code section shall be995 construed as permitting any authority created under this article or any qualified sponsor to996 finance, construct, or operate any project without obtaining any certificate of need or other997 approval, permit, or license which, under the laws of this state, is required in connection998 therewith."999 - 39 - 26 LC 52 1109S SECTION 2-9.1000 Said title is further amended in said chapter by repealing and reserving Code1001 Section 31-7-155, relating to certificates of need for new service or extending service area1002 and exemption from certificate.1003 SECTION 2-10.1004 Said title is further amended in said chapter by repealing Code Section 31-7-179, relating to1005 certificate of need not required.1006 SECTION 2-11.1007 Said title is further amended in said chapter by revising Code Section 31-7-307, relating to1008 certificate of need not required of licensees and operation of licensee as home health agency1009 not authorized, as follows:1010 "31-7-307.1011 (a) A certificate of need issued pursuant to Chapter 6 of this title is not required for any1012 person, business entity, corporation, or association, whether operated for profit or not for1013 profit, which is operating as a private home care provider as long as such operation does1014 not also constitute such person, entity, or organization operating as a home health agency1015 or personal care home under this chapter.1016 (b) A license issued under this article shall not entitle the lic ensee to operate as a home1017 health agency, as defined in Code Section 31-7-150, under medicare Medicare or Medicaid1018 guidelines."1019 SECTION 2-12.1020 Said title is further amended in Chapter 8, relating to care an d protection of indigent and1021 elderly patients, by revising Code Section 31-8-181, relating t o individuals and hospitals1022 excluded from application of article, as follows:1023 - 40 - 26 LC 52 1109S "31-8-181.1024 This article shall not apply to the following:1025 (1) An individual licensed to practice medicine under the prov isions of Chapter 34 of1026 Title 43, and persons employed by such an individual, provided that any nursing home,1027 personal care home as defined by Code Section 31-6-2 31-7-12, hospice as defined by1028 Code Section 31-7-172, respite care service as defined by Code Section 49-6-72, adult1029 day program, or home health agency owned, operated, managed, or controlled by a1030 person licensed to practice medicine under the provisions of Chapter 34 of Title 43 shall1031 be subject to the provisions of this article; or1032 (2) A hospital. However, to the extent that a hospital's nurs ing home, personal care1033 home as defined by Code Section 31-6-2 31-7-12 , hospice as defined by Code1034 Section 31-7-172, respite care service as defined by Code Secti on 49-6-72, adult day1035 program, or home health agency holds itself out as providing ca re, treatment, or1036 therapeutic activities for persons with Alzheimer's disease or Alzheimer's related1037 dementia as part of a specialty unit, such nursing home, person al care home, hospice,1038 respite care service, adult day program, or home health agency shall be subject to the1039 provisions of this article."1040 SECTION 2-13.1041 Said title is further amended in said chapter by revising Code Section 31-8-153.1, relating1042 to irrevocable transfer of funds to trust fund and provision for indigent patients, as follows:1043 "31-8-153.1.1044 After June 30, 1993, any hospital authority, county, municipali ty, or other state or local1045 public or governmental entity is authorized to transfer moneys to the trust fund. Transfer1046 of funds under the control of a hospital authority, county, mun icipality, or other state or1047 local public or governmental entity shall be a valid public purpose for which those funds1048 may be expended. The department is authorized to transfer to the trust fund moneys paid1049 - 41 - 26 LC 52 1109S to the state by a health care healthcare facility as a monetary penalty for the violation of an1050 agreement to provide a specified amount of clinical health serv ices to indigent patients1051 uncompensated indigent or charity care pursuant to a certificate of need license held by1052 such facility. Such transfers shall be irrevocable and shall be used only for the purposes1053 contained in Code Section 31-8-154."1054 SECTION 2-14.1055 Said title is further amended in Chapter 11, relating to emerge ncy medical services, by1056 revising paragraph (3) of Code Section 31-11-100, relating to Georgia Trauma Care Network1057 Commission, as follows:1058 "(3) 'Trauma center' means a facility designated by the Department of Public Health as1059 a Level I, II, III, or IV or burn trauma center. However, a burn trauma center shall not1060 be considered or treated as a trauma center for purposes of cer tificate of need1061 requirements under state law or regulations, including exceptio ns to need and adverse1062 impact standards allowed by the department for trauma centers o r for purposes of1063 identifying safety net hospitals."1064 SECTION 2-15.1065 Said title is further amended in Chapter 54, relating to hospit al peace officers, by revising1066 paragraph (1) of Code Section 31-54-1, relating to definitions, as follows:1067 "(1) 'Hospital' shall have the same meaning as provided in Code Section 31-6-2 means1068 a facility that is permitted to operate as a hospital pursuant to Article 1 of Chapter 7 of1069 this title."1070 - 42 - 26 LC 52 1109S SECTION 2-16.1071 Title 33 of the Official Code of Georgia Annotated, relating to insurance, is amended in1072 Chapter 45, relating to continuing care providers and facilities, by revising subparagraph (A)1073 of paragraph (1) of Code Section 33-45-1, relating to definitions, as follows:1074 "(A) Lodging that is not:1075 (i) In a skilled nursing facility, as such term is defined in Code Section 31-6-21076 31-6-1;1077 (ii) An intermediate care facility, as such term is defined in Code Section 31-6-21078 31-7-1;1079 (iii) An assisted living community, as such term is defined in Code1080 Section 31-7-12.2; or1081 (iv) A personal care home, as such term is defined in Code Section 31-7-12;"1082 SECTION 2-17.1083 Said title is further amended in said chapter by revising subse ctions (b) and (d) of Code1084 Section 33-45-3, relating to certificate of authority required for operation of life plan1085 communities, as follows:1086 "(b) Nothing in this chapter shall be construed so as to modify or limit in any way:1087 (1) Provisions of Article 3 of Chapter 6 of Title 31 and any r ules and regulations1088 promulgated by the Department of Community Health pursuant to such article relating1089 to certificates of need for life plan communities or home health agencies, as such terms1090 are defined in Code Section 31-6-2; or1091 (2) Provisions provisions of Chapter 7 of Title 31 relating to licensure or permit1092 requirements and any rules and regulations promulgated by the D epartment of1093 Community Health pursuant to such chapter, including, without limitation, licensure or1094 permit requirements for nursing home care, assisted living care , personal care home1095 services, home health services, and private home care services."1096 - 43 - 26 LC 52 1109S "(d) A provider of continuing care at home may contract with a licensed home health1097 agency to provide home health services to a resident. In order to provide home health1098 services directly, a provider of continuing care at home shall obtain a certificate of need for1099 a home health agency, as such term is defined in Code Section 31-6-2, pursuant to the same1100 criteria and rules as are applicable to freestanding home healt h agencies that are not1101 components of life plan communities."1102 SECTION 2-18.1103 Said title is further amended in said chapter by revising Code Section 33-45-7.1, relating to1104 provider authorized to offer continuing care when resident purchases resident owned living1105 unit, as follows:1106 "33-45-7.1.1107 A provider which has obtained a certificate of authority pursuant to Code Section 33-45-51108 and the written approval of the Commissioner is authorized to o ffer, as a part of the1109 continuing care agreement, continuing care at home or continuin g care in which the1110 resident purchases a resident owned living unit, subject to the provisions of Chapters 6 and1111 Chapter 7 of Title 31 and rules and regulations promulgated by the Dep artment of1112 Community Health pursuant to such chapters chapter relating to certificate of need and1113 licensure requirements."1114 SECTION 2-19.1115 Title 37 of the Official Code of Georgia Annotated, relating to mental health, is amended by1116 revising subsection (j) of Code Section 37-1-29, relating to cr isis stabilization units, as1117 follows:1118 "(j) Any program certified as a crisis stabilization unit pursuant to this Code section shall1119 be exempt from the requirements to obtain a certificate of need pursuant to Article 3 of1120 Chapter 6 of Title 31. Reserved."1121 - 44 - 26 LC 52 1109S SECTION 2-20.1122 Title 43 of the Official Code of Georgia Annotated, relating to profession and businesses, is1123 amended in Chapter 26, relating to nurses, by revising subparag raph (c)(4)(C) and the1124 undesignated text at the end of paragraph (4) of subsection (c) of Code Section 43-26-7,1125 relating to requirements for licensure as registered professional nurse and requirements for1126 nontraditional nursing education program, as follows:1127 "(C) If the applicant entered a nontraditional nursing educatio n program as anything1128 other than a licensed practical nurse whose academic education as a licensed practical1129 nurse included clinical training in pediatrics, obstetrics and gynecology,1130 medical-surgical, and mental illness, have graduated from such program and practiced1131 nursing as a registered professional nurse in a health care healthcare facility for at least1132 two years in the five years preceding the date of the applicati on, and such practice is1133 documented by the applicant and approved by the board; provided, however, that for1134 an applicant who does not meet the experience requirement of this subparagraph, the1135 board shall require the applicant to complete a postgraduate pr eceptorship of at least1136 480 hours but not more than 640 hours, as determined by the boa rd, arranged by the1137 applicant under the oversight of a registered professional nurse where such applicant1138 is transitioned into the role of a registered professional nurse. The preceptorship shall1139 have prior approval of the board, and successful completion of the preceptorship shall1140 be verified in writing by the preceptor.1141 For purposes of this paragraph, the term 'health care 'healthcare facility' means an acute1142 care inpatient facility, a long-term acute care facility, an am bulatory surgical center or1143 obstetrical facility as defined in Code Section 31-6-2 , and a skilled nursing facility, so1144 long as such skilled nursing facility has 100 beds or more and provides health care1145 healthcare to patients with similar health care healthcare needs as those patients in a1146 long-term acute care facility;"1147 - 45 - 26 LC 52 1109S SECTION 2-21.1148 Title 50 of the Official Code of Georgia Annotated, relating to state government, is amended1149 in Chapter 26, relating to housing and finance authority, by revising subsection (c) of Code1150 Section 50-26-19, relating to financing, acquisition, construct ion, and equipping of health1151 care facilities, as follows:1152 "(c) The authority may not finance a project for any participat ing provider unless the1153 Department of Community Health, or any successor thereof, has issued a certificate of need1154 or comparable certification of approval to the participating provider for the project to be1155 financed by the authority if the acquisition of such project by the participating provider1156 would require a certificate of need or comparable certification of approval under Chapter 61157 of Title 31."1158 SECTION 2-22.1159 Title 51 of the Official Code of Georgia Annotated, relating to torts, is amended in1160 Chapter 16, relating to COVID-19 pandemic business safety, by r evising paragraph (5) of1161 Code Section 51-16-1, relating to definitions, as follows:1162 "(5) 'Healthcare facility' shall have the same meaning as 'healthcare facility' as provided1163 for in paragraph (17) of Code Section 31-6-2 means hospitals; destination cancer1164 hospitals; other special care units, including but not limited to podiatric facilities; skilled1165 nursing facilities; intermediate care facilities; personal care homes; ambulatory surgical1166 centers or obstetrical facilities; freestanding emergency depar tments or facilities not1167 located on a hospital's primary campus; health maintenance organizations; home health1168 agencies; and diagnostic, treatment, or rehabilitation centers and all related parties;. Such1169 term shall have the same meaning as 'institution' as provided for in subparagraphs (A) and1170 (C) through (G) of paragraph (4) and paragraph (5) of Code Section 31-7-1 and all related1171 parties; as 'end stage renal disease facility ' as provided for in paragraph (6) of Code1172 Section 31-44-1 and all related parties; and shall mean the rec ipient of a contract as1173 - 46 - 26 LC 52 1109S authorized in paragraph (5) of Code Section 37-1-20 and any clinical laboratory certified1174 under the Clinical Laboratory Improvement Amendments in Section 353 of the Public1175 Health Service Act, 42 U.S.C. Section 263a. Such term shall not be construed to include1176 premises."1177 PART III1178 Rural hospital authorities and coordinated healthcare planning1179 SECTION 3-1.1180 Title 31 is further amended in Article 4 of Chapter 7, relating to county and municipal1181 hospital authorities, by revising paragraph (2) of Code Section 31-7-71, relating to1182 definitions, as follows:1183 "(2) 'Authority' or 'hospital authority' means any public corpo ration created by this1184 article. Such term shall include rural hospital authority as d efined in Code1185 Section 31-7-100."1186 SECTION 3-2.1187 Said chapter is further amended in said article by revising sub section (e) of Code1188 Section 31-7-72.1, relating to merger of hospital authorities, as follows:1189 "(e) It is declared by the General Assembly of Georgia that in the exercise of the power1190 specifically granted to them by this Code section, hospital authorities are acting pursuant1191 to state policy and shall be immune from antitrust liability to the same degree and extent1192 as enjoyed by the State of Georgia; provided, however, that any rural hospital authority1193 exercising powers as authorized pursuant to Article 4A of this chapter shall be immune1194 from antitrust liability as provided therein."1195 - 47 - 26 LC 52 1109S SECTION 3-3.1196 Said chapter is further amended by adding a new article to read as follows:1197 "ARTICLE 4A1198 31-7-100.1199 (a) It is the intent of the General Assembly to deem rural hospital authorities immune from1200 federal antitrust laws when acting as expressly authorized by this article and Article 4 of1201 this chapter. The express intent of the General Assembly is to avoid weakening antitrust1202 provisions applicable to: any group of hospitals that includes any hospital that is not a rural1203 hospital authority; any hospital authority that is not a rural hospital authority; or any group1204 of four or more rural hospital authorities.1205 (b) The General Assembly finds that:1206 (1) Rural hospital authorities are unique and have different i nterests from nonrural1207 hospital authorities or healthcare systems that include nonrura l hospitals and nonrural1208 hospital authorities;1209 (2) Rural hospital authorities perform essential public and go vernmental functions on1210 behalf of this state and the counties and municipalities that activate them by providing1211 healthcare services to the indigent sick, expanding access to healthcare, promoting public1212 health, supporting medical education and research, sustaining rural healthcare providers,1213 and maintaining healthcare infrastructure in communities throughout this state;1214 (3) In today's healthcare marketplace, any difference between the levels of charity care1215 and care provided to the indigent sick by hospitals is not a c onsequence of being a1216 hospital authority or a hospital's tax status;1217 (4) Hospitals of every kind, regardless of whether public or private or whether they pay1218 taxes, provide critical services, including those identified in paragraph (2) of this1219 subsection; 1220 - 48 - 26 LC 52 1109S (5) Healthcare delivery in rural counties that have a rural hospital authority, as well as1221 rural counties without a hospital but adjacent to a county with a rural hospital authority,1222 can be significantly enhanced through coordinated planning, joi nt operations, and1223 collaborative arrangements among rural hospital authorities. Accordingly, rural hospital1224 authorities may find it necessary to achieve efficiency, reduce costs, improve quality,1225 expand access to services, attract and retain healthcare professionals, maintain financial1226 viability of essential healthcare facilities, and respond effec tively to public health1227 emergencies and evolving community health needs; and1228 (6) The nature and scope of the powers conferred on rural hospital authorities operating1229 in rural counties pursuant to this article and Article 4 of this chapter may compel such an1230 authority, in the course of exercising its powers or by virtue of such exercise of powers,1231 to engage in activities itself or in collaboration with other rural hospital authorities, public1232 or private healthcare entities operating exclusively in rural counties, regardless of such1233 entities' tax status, and persons operating exclusively in rura l counties, that may be1234 characterized as anticompetitive or may result in the acquisition or maintenance of market1235 power within the meaning of federal antitrust laws or may have the effect of displacing1236 competition in the provision of hospital, physician, or other healthcare related services.1237 (c) Based on the findings provided in subsection (b) of this C ode section, the General1238 Assembly hereby declares, as expressions of the public policy of this state with respect to1239 the displacement of competition in the field of healthcare in only those rural counties with1240 a rural hospital authority or with no hospital but adjacent to a rural county with a rural1241 hospital authority: 1242 (1) The powers granted to rural hospital authorities under this article are conferred for1243 the purpose of carrying out the state's public health mission i n rural counties. The1244 exercise of such powers in accordance with this article constitutes implementation of the1245 express policy of this state, and such powers constitute a clea rly articulated and1246 affirmatively expressed state policy to displace competition with regulation or monopoly1247 - 49 - 26 LC 52 1109S public service in the field of healthcare delivery in rural counties where a rural hospital1248 authority is the only hospital and in rural counties without a hospital adjacent to a rural1249 county with a rural hospital authority; and1250 (2) The potential anticompetitive effects of conduct of a rura l hospital authority as1251 authorized by this article are a foreseeable result of the powers granted herein, and such1252 potential anticompetitive effects are consistent with the state 's policy of promoting1253 coordinated healthcare delivery through rural hospital authorities in counties without a1254 hospital or where the rural hospital authority is the only hospital.1255 (d) The provisions of this Code section shall be narrowly construed.1256 31-7-101.1257 As used in this article, the term:1258 (1) 'Healthcare system' means a group of hospitals that are af filiated, share common1259 direct or indirect ownership, or do business under a common nam e. Such term also1260 means any physician group that is affiliated with such a group of hospitals.1261 (2) 'Hospital authority' shall have the same meaning as set forth in Code Section 31-7-71.1262 (3) 'Project' shall have the same meaning as set forth in Code Section 31-7-71.1263 (4) 'Restructured rural hospital authority' means an entity that leases its operating assets1264 from a hospital authority organized and created by resolution t hat includes at least one1265 member of such hospital authority on the restructured governing board and operates a1266 project in a rural county.1267 (5) 'Rural county' means any county in this state having a population of less than 50,0001268 according to the United States decennial census of 2020 or any future such census.1269 (6) 'Rural hospital authority' means a hospital authority or a restructured rural hospital1270 authority that is located in a rural county or that is part of a rural hospital authority that1271 operates only in rural counties. Such authority shall not be affiliated with more than two1272 other rural hospital authorities. Such authority shall not be affiliated directly or indirectly1273 - 50 - 26 LC 52 1109S with any hospital authority that operates directly or indirectly in a nonrural county, that1274 operates directly or indirectly more than two other hospitals o f any kind located in a1275 nonrural county, or is part of a healthcare system that include s two or more other1276 affiliated hospitals of any kind located in a nonrural county.1277 (7) 'Rural physician practice' means a group of physicians or physician practices that1278 perform medical care and treatment exclusively in a rural county or rural counties and are1279 not affiliated with any hospital, hospital authority, or healthcare system that is not a rural1280 hospital authority.1281 31-7-102.1282 (a) Rural hospital authorities may engage in conduct authorized pursuant to Article 4 of1283 this chapter and this article.1284 (b) Based on the legislative findings and expression of public policy set forth in Code1285 Section 31-7-100, rural hospital authorities may engage in coordinated healthcare planning1286 and delivery for the provision of healthcare services in rural counties, including but not1287 limited to:1288 (1) Mergers, acquisitions, consolidations, and affiliations with no more than two other1289 rural hospital authorities or rural physician practices per corporate restructuring;1290 (2) Joint ventures, partnerships, and collaborative arrangements with no more than two1291 other rural hospital authorities or rural physician practices per strategic alliance;1292 (3) Coordinated or joint negotiations with other rural hospita l authorities or rural1293 physician practices and third-party payors, health insurers, an d managed care1294 organizations, whether such negotiations result in separate or combined agreements,1295 provided that each such agreement is with no more than two othe r rural hospital1296 authorities;1297 (4) Joint purchasing arrangements and shared services agreements with no more than two1298 rural hospital authorities or rural physician practices per arrangement or agreement;1299 - 51 - 26 LC 52 1109S (5) Shared staffing to promote flexible staffing among rural hospital authorities or rural1300 physician practices;1301 (6) Coordinated decisions among no more than two rural hospital authorities regarding1302 the allocation, expansion, reduction, or discontinuation of healthcare services and service1303 lines in rural counties;1304 (7) Agreements between no more than two rural hospital authorities regarding pricing,1305 reimbursement rates, or the terms of contracts with third-party payors and other third1306 parties;1307 (8) Information sharing with public or private entities and individuals; and1308 (9) The creation or operation of or participation in delivery system networks, clinically1309 integrated networks, and accountable care organizations in a ru ral county or rural1310 counties for use of rural hospital authorities and rural physician practices.1311 31-7-103.1312 (a) Rural hospital authorities exercising any power granted under Article 4 of this chapter1313 or this article, including, but not limited to, the power to me rge with other rural hospital1314 authorities, to consolidate opera tions, to affiliate with other rural hospital authorities or1315 rural physician practices, to coordinate healthcare planning and delivery with other rural1316 hospital authorities or rural physician practices, and to engage in the collaborative activities1317 described in Code Sections 31-7-75 and 31-7-102 with other rural hospital authorities or1318 rural physician practices, shall be immune from antitrust liability under any federal laws1319 to the same degree and extent as enjoyed by the state.1320 (b) Without limiting the provisions of subsection (a) of this Code section, rural hospital1321 authorities exercising powers pursuant to Article 4 of this cha pter or this article shall be1322 immune from liability under federal antitrust laws, including without limitation the federal1323 Sherman Act, 15 U.S.C. Section 1, et seq., the federal Clayton Act, 15 U.S.C. Section 12,1324 et seq., and the Federal Trade Commission Act, 15 U.S.C. Section 41, et seq., as well as1325 - 52 - 26 LC 52 1109S any state law counterpart thereto or any other state or federal law prohibiting or regulating1326 anticompetitive conduct, monopolization, restraints of trade, o r unfair methods of1327 competition; provided, however, such immunity shall not extend to any prohibition in the1328 Constitution of Georgia.1329 (c) Each rural hospital authority exercising powers granted under Article 4 of this chapter1330 or this article:1331 (1) Acts as an agency or instrumentality of the county or municipality that activated it1332 and as a public body corporate and politic. For purposes of an y federal antitrust law,1333 including the application of the state action doctrine as devel oped in federal antitrust1334 jurisprudence, each rural hospital authority shall be deemed a political subdivision of this1335 state; and1336 (2) Shall not be subject to active state supervision in order to enjoy immunity from the1337 application of any federal antitrust laws when the rural hospit al authority collaborates1338 with any other rural hospital authority or rural physician practice. To the extent that any1339 court or regulatory body determines that active state supervisi on is required for any1340 person or entity to assert immunity under this subsection, the General Assembly hereby1341 designates the governing body of the rural county or municipality that activated the rural1342 hospital authority or, if activated by multiple governing bodie s, the governing bodies1343 acting jointly as the state actor r esponsible for supervising t he conduct of the rural1344 hospital authority, and such governing body or bodies are hereby authorized and directed1345 to review, approve, and supervise agreements and collaborative arrangements entered into1346 between any rural hospital authorities and rural physician prac tices pursuant to this1347 article.1348 31-7-104.1349 (a) The immunity from antitrust liability under any federal la ws established pursuant to1350 Code Section 31-7-103 extends only to the following persons:1351 - 53 - 26 LC 52 1109S (1) A rural hospital authority or group of no more than three rural hospital authorities1352 exercising powers granted under Article 4 of this chapter or this article, with or without1353 a rural physician practice;1354 (2) Any surviving, resulting, or successor rural hospital authority that continues to satisfy1355 the definition of a rural hospital authority following a merger, acquisition, consolidation,1356 or other combination authorized under this article; 1357 (3) Any members of the board of a rural hospital authority and any officers, employees,1358 or agents of a rural hospital authority acting within the scope of the rural hospital1359 authority only;1360 (4) Any rural hospital authority, rural physician practice, or other person who1361 collaborates with a rural hospital authority in a manner expres sly authorized by this1362 article; and 1363 (5) Any entity controlled by or under common control with a ru ral hospital authority,1364 including without limitation any nonprofit subsidiary, affiliat e, joint venture, or other1365 entity in which a rural hospital authority has an ownership or membership interest.1366 (b) The immunity from antitrust liability under any federal laws established pursuant to1367 Code Section 31-7-103 and as limited pursuant to subsection (a) of this Code section shall1368 apply to:1369 (1) Any action, suit, or proceeding brought by the Federal Trade Commission, the United1370 States Department of Justice, or any other federal agency or instrumentality under federal1371 antitrust laws only;1372 (2) Any action, suit, or proceeding brought by this state, the Attorney General, or any1373 other state agency or instrumentality for antitrust laws only;1374 (3) Any action, suit, or proceeding brought by any county, municipality, or other political1375 subdivision of this state for antitrust laws only;1376 (4) Any private action, suit, or proceeding, including without limitation any action for1377 damages, injunctive relief, or other remedy under federal or state antitrust laws; and1378 - 54 - 26 LC 52 1109S (5) Any investigation, inquiry, civil investigative demand, su bpoena, or other1379 compulsory process issued in connection with any antitrust law.1380 (c) The provisions of this Code section shall be narrowly construed.1381 31-7-105.1382 (a) Nothing in this article shall be construed as:1383 (1) Extending sovereign immunity to any hospital authority;1384 (2) Applying to any hospital, hospital authority, or restructured hospital authority located1385 in any nonrural county;1386 (3) Applying to any group of hospitals of any kind when any hospital in the group is not1387 a rural hospital authority;1388 (4) Applying to any physician practice that is affiliated with any hospital or group of1389 hospitals that is not a rural hospital authority;1390 (5) Applying to mergers, acquisitions, or other any other collaboration between a rural1391 hospital authority and hospital of any kind that is not a rural hospital authority or between1392 a rural hospital authority and a healthcare system that includes any hospital that is not a1393 rural hospital authority; or1394 (6) Applying to a merger, acquisition, consolidation, or other combination between more1395 than three rural hospital authorities.1396 (b) Nothing in this article shall be construed to authorize conduct that would violate any1397 other applicable state or federal law, rule, or regulation, oth er than the antitrust laws1398 addressed herein.1399 (c) No immunity granted by this article shall apply any action arising under the1400 Constitution of the United States or the Constitution of Georgi a, arising out of common1401 law, or based on a statute other than federal antitrust law.1402 (d) Any ambiguity in the scope or application of this Code sec tion shall be resolved1403 against the grant of immunity.1404 - 55 - 26 LC 52 1109S 31-7-106.1405 (a) No rural hospital authority shall be able to assert the im munity to antitrust laws1406 provided in this article prior to satisfaction of the notice an d review requirements as1407 follows:1408 (1) The rural hospital authority shall provide written notice to the Governor, the Attorney1409 General, the President of the Senate, the Speaker of the House of Representatives, and1410 the chairpersons of the House Committees on Judiciary and Healt h and the Senate1411 Judiciary and Health and Human Services Committees of its intent to assert the immunity1412 to antitrust laws provided in this article;1413 (2) Upon receiving such notice from a rural hospital authority, the Attorney General shall1414 post the notice on his or her official website and shall have n ot more than 180 days to1415 conduct a review to determine whether the rural hospital authority satisfies the statutory1416 criteria provided in this article;1417 (3) During the review process, the rural hospital authority sh all provide any requested1418 documents to the Attorney General within a reasonable amount of time, not to exceed1419 15 calendar days. If the rural hospital authority fails to pro vide any such requested1420 documents within such time, the Attorney General shall deny the rural hospital authority's1421 request to assert the immunity to antitrust laws provided in this article. If a rural hospital1422 authority claims that the request of the Attorney General is un lawful, it may seek a1423 remedy in the Superior Court of Fulton County;1424 (4) The immunity to antitrust laws provided in this article to rural hospital authorities1425 shall not be effective until the Attorney General determines th at the rural hospital1426 authority satisfies all the statutory criteria provided in this article and indicates the same1427 by written notice published on the Attorney General's website;1428 (5) If the Attorney General determines that the rural hospital authority satisfies all the1429 statutory criteria provided in this article for such rural hosp ital authority to assert the1430 immunity to antitrust laws provided in this article, such rural hospital authority shall have1431 - 56 - 26 LC 52 1109S ten days to notify in writing the United States Attorney Genera l and the Chair of the1432 Federal Trade Commission of such determination. Any failure to comply with this1433 paragraph by the rural hospital authority will deprive such rur al hospital authority the1434 ability to assert the immunity to antitrust laws provided in this article;1435 (6) Any hospital or healthcare provider located in an adjacent county to or within 351436 miles of the rural hospital authority that seeks to assert the immunity to antitrust laws1437 provided in this article may submit its objection to the Attorney General no later than 301438 days after the notice is published pursuant to paragraph (2) of this subsection. The1439 Attorney General shall consider such objection before making the determination required1440 by paragraph (5) of this subsection;1441 (7) Any person aggrieved by the Attorney General's determination under this subsection1442 may seek judicial review as set forth in Chapter 3 of Title 5, provided that such person1443 submitted objections to the Attorney General as set forth in pa ragraph (6) of this1444 subsection; and1445 (8) The immunity to antitrust laws provided in this article to rural hospital authorities1446 shall not be effective for any action filed before the Attorney General determines that the1447 rural hospital authority satisfies the statutory criteria provi ded in this article. If the1448 Attorney General's determination is reversed by final order on judicial review, the grant1449 of such immunity shall be deemed null and void.1450 (b) Notwithstanding any provision contained in Article 4 of Chapter 8 of Title 13, a rural1451 hospital authority that has successfully asserted the immunity to antitrust laws provided by1452 this article shall be ineligible to enter into a restrictive co venant in contract with any1453 physician, nurse, or other healthcare provider licensed under a provision of Title 43.1454 (c) Any rural hospital authority that has asserted the immunity to antitrust law provided in1455 this article and satisfied statutory criteria as determined by the Attorney General shall be1456 deemed to be a private state actor pursuant to 42 U.S.C. Section 1983; provided, however,1457 - 57 - 26 LC 52 1109S that such determination shall not establish that all actions of such rural hospital authority1458 are made under color of state law.1459 (d) Any rural hospital authority that has asserted the immunity to antitrust law provided in1460 this article shall, no later than June 30 of each year, provide a sworn statement to the1461 Attorney General that it continues to meet the definition of a rural hospital authority. The1462 failure to timely provide such notice shall render such immunity to antitrust law no longer1463 valid as a matter of law. Any rural hospital authority that ce ases to qualify for the1464 immunity to antitrust law provided in this article may seek to assert such immunity once1465 it qualifies or requalifies pursuant to review and determinatio n by the Attorney General1466 pursuant to this Code Section.1467 (e) A rural hospital authority that has asserted the immunity provided in this article may1468 request guidance from the Attorney General about whether a proposed transaction would1469 deprive the rural hospital authority of such immunity. The Attorney General shall have 901470 days to respond to the request, but the Attorney General's response shall not be binding.1471 (f) The Attorney General shall have the authority to ensure compliance with any and all1472 notices and obligations which are required to be made pursuant to this Code section. No1473 provision of this Code section shall derogate the common law or statutory authority of the1474 Attorney General.1475 (g) The Department of Community Health, in consultation with the Attorney General, shall1476 annually and as necessary review conduct of rural hospital auth orities to confirm1477 compliance with the provisions of this article; ensure that any displacement of competition1478 does not impair the public's access to quality and affordable h ealthcare services and the1479 state's duty to provide indigent care; and take necessary actio n against rural hospital1480 authorities."1481 - 58 - 26 LC 52 1109S PART IV1482 Effective date and repealer1483 SECTION 4-1.1484 This Act shall become effective upon its approval by the Governor or upon its becoming law1485 without such approval.1486 SECTION 4-2.1487 All laws and parts of laws in conflict with this Act are repealed.1488 - 59 -