Conning the Competition

Hospital Beds

Any increase in bed capacity in the following facilities.

Ga. Code§ 31-6-40(a)(4)

1.Hospital.

2.Destination cancer hospitals.

§ 31-6-2(17)

Beds Outside Hospitals

Any increase in bed capacity in the following facilities.

Ga. Code § 31-6-40(a)(4)

1.Special care units, including but not limited to podiatric facilities.

2.Skilled nursing facilities.

3.Intermediate care facilities.

4.Personal care homes.

5.Ambulatory surgical facilities.

6.Obstetrical facilities.

7.Freestanding emergency departments or facilities not located on a hospital’s primary campus.

8.Diagnostic, treatment or rehabilitation centers.

§§ 31-6-40(a)(4),

31-6-2(17)

Equipment

1.Diagnostic equipment.

2.Therapeutic equipment.

§ 31-6-40(a)(3)

The following equipment costing more than $2.99 million, as updated annually:

3.Computed tomography scanning.

4.Magnetic resonance imaging.

5.Positron emission tomography scanning.

§§ 31-6-2(15),

31-6-40(c)(2);

Update of CON Threshold (June 26, 2020)32

Facilities/Buildings

The construction, development or other establishment of a new, expanded or relocated facility.

Ga. Code § 31-6-40(a)(1).

1.Hospital.

2.Destination cancer hospital.

3.Special care unit, including but not limited to podiatric facilities.

4.Skilled nursing facility.

5.Intermediate care facility.

6.Personal care home.

7.Ambulatory surgical facility.

8.Obstetrical facility.

9.Freestanding emergency department or facility not located on a hospital’s primary campus.

10.Health maintenance organization.

11.Diagnostic, treatment or rehabilitation center.

§ 31-6-2(17)

12.Any conversion or upgrading of any general acute care hospital to a specialty hospital.

13.A facility converted from a type of facility not covered by this chapter to any of the types of health care facilities which are covered by this chapter.

§ 31-6-40(a)(6)

14.The conversion of a destination cancer hospital to a general cancer hospital.

§§ 31-6-40(8),

31-6-40.3

Category

Types of CONs

Ga. Code

Services

1.Imaging services.

2.Biliary lithotripsy.

3.Surgery.

4.Intensive care.

5.Coronary care.

6.Pediatrics.

7.Gynecology.

8.Obstetrics.

9.General medical care.

10.Medical-surgical care.

11.Inpatient nursing care.

12.Cardiac catheterization.

13.Open heart surgery.

14.Inpatient rehabilitation.

15.Alcohol or drug abuse services.

16.Mental Health services.

17.Any of the previous services not offered within the prior 12-month period, if offered at the following facilities:

»Hospitals.

»Destination cancer hospitals.

»Special care units, including but not limited to podiatric facilities.

»Skilled nursing facilities.

»Intermediate care facilities.

»Personal care homes.

»Ambulatory surgical or obstetrical facilities.

»Freestanding emergency departments or facilities not located on a hospital’s primary campus.

»Health maintenance organizations.

»Home health agencies.

»Diagnostic, treatment or rehabilitation centers.

§§ 31-6-2(8),

31-6-40(a)(5),

31-6-2(17)

The following services if offered in or through a diagnostic, treatment or rehabilitation center and if they were not offered on a regular basis in or through that center within the previous 12 months:

18.Radiation therapy.

19.Biliary lithotripsy.

20.Surgery in an operating room, including but not limited to ambulatory surgery.

21.Cardiac catheterization.

22.Any expenditure above $10 million, as adjusted annually, for new health care services.

§§ 31-6-40(a)(7), 31-6-40(a)(7)(A)-(D), 31-6-40(a)(2)

Emergency Medical Transport

No CONs in this category.

1.Infirmaries operated by educational institutions for the sole and exclusive benefit of students, faculty members, officers or employees thereof.

§ 31-6-47(a)(1)

2.Infirmaries or facilities operated by businesses for the sole and exclusive benefit of officers or employees thereof, provided that such infirmaries or facilities make no provision for overnight stay by persons receiving their services.

§ 31-6-47(a)(2)

3.Institutions operated exclusively by the federal government or by any of its agencies.

§ 31-6-47(a)(3)

4.Offices of private physicians or dentists whether for individual or group practice.

§ 31-6-47(a)(4)

5.Religious, nonmedical health care institutions listed and certified by a national accrediting organization.

§ 31-6-47(a)(5)

6.Site acquisitions for health care facilities or preparation or development costs for such sites prior to the decision to file a CON application.

§ 31-6-47(a)(6)

7.Expenditures related to adequate preparation and development of an application for a CON.

§ 31-6-47(a)(7)

8.The commitment of funds conditioned upon the obtaining of a CON.

§ 31-6-47(a)(8)

9.Expenditures for the restructuring or acquisition of existing health care facilities by stock or asset purchase, merger, consolidation or other lawful means.

§ 31-6-47(a)(9)

10.The purchase of a closing hospital or of a hospital that has been closed for no more than 12 months by a hospital in a contiguous county to repurpose the facility as a micro-hospital.

§ 31-6-47(a)(9.1)

11.Expenditures of less than $870,000 for any repair or replacement of equipment by a health care facility that is not owned by a group practice of physicians or a hospital and that provides diagnostic imaging services if such facility received a letter of nonreviewability from the department prior to July 1, 2008. This paragraph shall not apply to such facilities in rural counties.

§ 31-6-47(a)(10)

12.Except as provided above, expenditures for the repair of a health care facility or a facility that is exempt from the requirements of this chapter, parts thereof or services provided or equipment used therein; or the replacement of equipment, including but not limited to CT scanners, magnetic resonance imaging, positron emission tomography (PET) and positron emission tomography/computed tomography previously approved for a certificate of need.

§ 31-6-47(a)(10.1)

13.Capital expenditures required solely to eliminate or prevent safety hazards, to comply with licensing requirements of the department, or to comply with accreditation standards of a nationally recognized health care accreditation body.

§ 31-6-47(a)(11)

14.Cost overruns whose percentage of the cost of a project is equal to or less than the cumulative annual rate of increase in the composite construction index, published by the United States Bureau of the Census of the Department of Commerce, calculated from the date of approval of the project.

§ 31-6-47(a)(12)

15.Transfers from one health care facility to another such facility of major medical equipment previously approved or exempted from certificate of need review.

§ 31-6-47(a)(13)

16.New institutional health services provided by or on behalf of health maintenance organizations or related health care facilities in circumstances defined by the department pursuant to federal law.

§ 31-6-47(a)(14)

17.Increases in the bed capacity of a hospital up to ten beds or 10% of capacity, whichever is greater, in any consecutive two-year period, in a hospital that has maintained an overall occupancy rate greater than 75% for the previous 12-month period.

§ 31-6-47(a)(15)

18.Expenditures for nonclinical projects.

§ 31-6-47(a)(16)

No CON Required For:

Ga. Code

19.Life plan communities, provided that the skilled nursing component of the facility is for the exclusive use of residents of the life plan community and that a written exemption is obtained from the department; provided, however, that new sheltered nursing home beds may be used on a limited basis by persons who are not residents of the life plan community for a period up to five years after the date of issuance of the initial nursing home license, but such beds shall not be eligible for Medicaid reimbursement.

§ 31-6-47(a)(17)

20.Single specialty ambulatory surgical center that (A) (i) does not exceed $2.5 million; or (ii) is the only single specialty ambulatory surgical center in the county owned by the group practice and has two or fewer operating rooms, so long as they get a CON to add operating rooms; (B) has a hospital affiliation agreement with a hospital in reasonable distance or has medical staff with admitting privileges with such hospital to ensure necessary backup for medical complications, the center must be able to transfer a patient to a hospital within reasonable distance; (C) (i) provides care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids beneficiaries and provides uncompensated indigent and charity care in an amount equal to or greater than 2% of its adjusted gross revenue; or (ii) if the center is not a participant in Medicaid or the PeachCare for Kids Program, provides uncompensated care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids beneficiaries, uncompensated indigent and charity care, or both in an amount equal to or greater than 4% of its adjusted gross revenue; provided, however, that single specialty ambulatory surgical centers owned by physicians in the practice of ophthalmology shall not be required to comply with this subparagraph; and (D) provides annual reports.

§ 31-6-47(a)(18)

21.Any joint venture ambulatory surgical center that: (A) has capital expenditures associated with the construction, development, or other establishment of the clinical health service which do not exceed $5 million; (B) (i) provides care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids beneficiaries and provides uncompensated indigent and charity care in an amount equal to or greater than 2% of its adjusted gross revenue; or (ii) if the center is not a participant in Medicaid or the PeachCare for Kids Program, provides uncompensated care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids beneficiaries, uncompensated indigent and charity care, or both in an amount equal to or greater than 4% of its adjusted gross revenue; and (C) provides annual reports.

§ 31-6-47(a)(19)

22.Expansion of services by an imaging center based on a population needs methodology taking into consideration whether the population residing in the area served by the imaging center has a need for expanded services, as determined by the department in accordance with its rules and regulations, if such imaging center: (A) was in existence and operational in Georgia on January 1, 2008; (B) is owned by a hospital or by a physician or a group of physicians comprising at least 80% ownership who are currently board certified in radiology; (C) provides three or more diagnostic and other imaging services; (D) accepts all patients regardless of ability to pay; and (E) provides uncompensated indigent and charity care in an amount equal to or greater than the amount of such care provided by the geographically closest general acute care hospital. However, this does not apply to an imaging center in a rural county.

§ 31-6-47(a)(20)

23.Diagnostic cardiac catheterization in a hospital setting on patients 15 years of age and older.

§ 31-6-47(a)(21)

24.Therapeutic cardiac catheterization in hospitals selected by the department prior to July 1, 2008, to participate in the Atlantic Cardiovascular Patient Outcomes Research Team (C-PORT) Study and therapeutic cardiac catheterization in hospitals that, as determined by the department on an annual basis, meet the criteria to participate in the C-PORT Study but have not been selected for participation; provided, however, that if the criteria requires a transfer agreement to another hospital, no hospital shall unreasonably deny a transfer agreement to another hospital.

§ 31-6-47(a)(22)

No CON Required For:

Ga. Code

25.Infirmaries or facilities operated by, on behalf of, or under contract with the Department of Corrections or the Department of Juvenile Justice for the sole and exclusive purpose of providing health care services in a secure environment to prisoners within a penal institution, penitentiary, prison, detention center,or other secure correctional institution, including correctional institutions operated by private entities in this state which house inmates under the Department of Corrections or the Department of Juvenile Justice.

§ 31-6-47(a)(23)

26.The relocation of any skilled nursing facility, intermediate care facility or micro-hospital within the same county, any other health care facility in a rural county within the same county, and any other health care facility in an urban county within a three-mile radius of the existing facility so long as the facility does not propose to offer any new or expanded clinical health services at the new location.

§ 31-6-47(a)(24)

27.Facilities which are devoted to the provision of treatment and rehabilitative care for periods continuing for 24 hours or longer for persons who have traumatic brain injury.

§ 31-6-47(a)(25)

28.Capital expenditures for a project otherwise requiring a CON if those expenditures are for a project to remodel, renovate, replace or any combination thereof, a medical-surgical hospital and (A) that hospital (i) Has a bed capacity of not more than 50 beds; (ii) Is located in a county in which no other medical-surgical hospital is located; (iii) Has at any time been designated as a disproportionate share hospital by the department; and (iv) Has at least 45% of its patient revenues derived from Medicare, Medicaid or any combination thereof, for the immediately preceding three years; and (B) That project: (i) Does not result in any of the following: (I) The offering of any new clinical health services; (II) Any increase in bed capacity; (III) Any redistribution of existing beds among existing clinical health services; or (IV) Any increase in capacity of existing clinical health services; (ii) Has at least 80% of its capital expenditures financed by the proceeds of a special purpose county sales and use tax imposed pursuant to Article 3 of Chapter 8 of Title 48; and (iii) Is located within a three-mile radius of and within the same county as the hospital’s existing facility.

§ 31-6-47(a)(26)

29.The renovation, remodeling, refurbishment or upgrading of a health care facility, so long as the project does not result in any of the following: (A) The offering of any new or expanded clinical health services; (B) Any increase in inpatient bed capacity; (C) Any redistribution of existing beds among existing clinical health services; or (D) A capital expenditure exceeding the threshold—defind in Ga. Code § 31-6-40(a)(2)

§ 31-6-47(a)(27)

30.Other than for equipment used to provide positron emission tomography (PET) services, the acquisition of diagnostic, therapeutic,or other imaging equipment with a value of $3 million or less, by or on behalf of: (A) A hospital; or (B) An individual private physician or single group practice of physicians exclusively for use on patients of such private physician or single group practice of physicians and such private physician or member of such single group practice of physicians is physically present at the practice location where the diagnostic or other imaging equipment is located at least 75% of the time that the equipment is in use.

§ 31-6-47(a)(28)

31.A capital expenditure of $10 million or less by a hospital at such hospital’s primary campus for: (A) The expansion or addition of the following clinical health services: operating rooms, other than dedicated outpatient operating rooms; medical-surgical services; gynecology; procedure rooms; intensive care; pharmaceutical services; pediatrics; cardiac care or other general hospital services; provided, however, that such expenditure does not include the expansion or addition of inpatient beds or the conversion of one type of inpatient bed to another type of inpatient bed; or (B) The movement of clinical health services from one location on the hospital’s primary campus to another location on such hospital’s primary campus.

§ 31-6-47(a)(29)