07 LC 37
0384
Senate
Bill 296
By:
Senators Hamrick of the 30th, Thomas of the 54th and Unterman of the 45th
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Chapter 6 of Title 31 of the Official Code of Georgia Annotated, relating
to state health planning and development, so as to revise certain definitions;
to change exemptions; to provide for related matters; to repeal conflicting
laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Chapter
6 of Title 31 of the Official Code of Georgia Annotated, relating to state
health planning and development, is amended by revising paragraphs (5), (7),
(8), and (14) of Code Section 31-6-2, relating to definitions, as
follows:
"(5)
'Clinical health services' means diagnostic, treatment, or rehabilitative
services provided in a health care facility, or parts of the physical plant
where such services are located in a health care facility, and includes, but is
not limited to, the following:
radiology
and diagnostic imaging, such as magnetic resonance imaging and positron emission
tomography; radiation therapy; biliary
lithotripsy; surgery; intensive care; coronary care; pediatrics; gynecology;
obstetrics; general medical care; medical/surgical care; inpatient nursing care,
whether intermediate, skilled, or extended care; cardiac catheterization;
open-heart surgery; inpatient rehabilitation; and alcohol, drug abuse, and
mental health services."
"(7)
'Develop,' with reference to a project, means:
(A)
Constructing, remodeling, installing, or proceeding with a project, or any part
of a project, or a capital expenditure project, the cost estimate for which
exceeds
$900,000.00
$2
million; or
(B)
The expenditure or commitment of funds exceeding
$500,000.00
$2
million for orders, purchases, leases, or
acquisitions through other comparable arrangements of major medical
equipment;
provided, however, that this shall not apply to radiology and diagnostic imaging
equipment, including but not limited to magnetic resonance imaging and positron
emission tomography.
Notwithstanding
subparagraphs (A) and (B) of this paragraph, the expenditure or commitment or
incurring an obligation for the expenditure of funds to develop certificate of
need applications, studies, reports, schematics, preliminary plans and
specifications, or working drawings or to acquire, develop, or prepare
sites; for the
construction of a parking deck or additional parking deck; or the remodeling or
renovation of a health care facility if it does not change or modify the scope
or type of service being provided, shall
not be considered to be the developing of a project."
"(8)
'Health care facility' means hospitals; other special care units, including but
not limited to podiatric facilities; skilled nursing facilities; intermediate
care facilities; personal care homes;
ambulatory
surgical or obstetrical facilities; health
maintenance organizations; home health agencies; diagnostic, treatment, or
rehabilitation centers, but only to the extent that subparagraph (G) or (H), or
both subparagraphs (G) and (H), of paragraph (14) of this Code section are
applicable thereto; and 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, as defined in Code Section
37-3-1."
"(14)
'New institutional health service' means:
(A)
The construction, development, or other establishment of a new health care
facility;
(B)
Any expenditure by or on behalf of a health care facility in excess of
$900,000.00
$2
million which, under generally accepted
accounting principles consistently applied, is a capital expenditure, except
expenditures for acquisition of an existing health care facility not owned or
operated by or on behalf of a political subdivision of this state, or any
combination of such political subdivisions, or by or on behalf of a hospital
authority, as defined in Article 4 of Chapter 7 of this title or certificate of
need owned by such facility in connection with its acquisition;
(C)
Any increase in the bed capacity of a health care facility except as provided in
Code Section 31-6-47;
(D)
Clinical health services which are offered in or through a health care facility,
which were not offered on a regular basis in or through such health care
facility within the 12 month period prior to the time such services would be
offered;
(E)
Any conversion or upgrading of a facility such that it is 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;
(F)
The purchase or lease by or on behalf of a health care facility of diagnostic or
therapeutic equipment with a value in excess of
$500,000.00
$800,000.00;
provided, however, that this shall not apply to radiology and diagnostic imaging
equipment, including, but not limited to, magnetic resonance imaging and
positron emission tomography. The
acquisition of one or more items of functionally related diagnostic or
therapeutic equipment shall be considered as one project;
(G)
Clinical health services which are offered in or through a diagnostic,
treatment, or rehabilitation center which were not offered on a regular basis in
or through that center within the 12 month period prior to the time such
services would be offered, but only if the clinical health services are any of
the following:
(i)
Radiation therapy;
(ii)
Biliary lithotripsy;
(iii)
Surgery in an operating room environment, including but not limited to
ambulatory surgery; provided, however,
that
this provision shall not apply to
surgery
performed in the offices of an individual private physician or single group
practice of private physicians if such surgery is performed in a facility that
is owned, operated, and utilized by such physicians who also are of a single
specialty and the capital expenditure associated with the construction,
development, or other establishment of the clinical health service does not
exceed the amount of $1 million
freestanding
ambulatory surgical or obstetrical
facilities; and
(iv)
Cardiac catheterization; or
(H)
The purchase, lease, or other use by or on behalf of a diagnostic, treatment, or
rehabilitation center of diagnostic or therapeutic equipment with a value in
excess of
$500,000.00
$800,000.00;
provided, however, that this shall not apply to radiology or diagnostic imaging
equipment, including, but not limited to, magnetic resonance imaging and
positron emission tomography equipment.
The acquisition of one or more items of functionally related diagnostic or
therapeutic equipment shall be considered as one project
except for
radiology and diagnostic imaging, such as magnetic resonance imaging and
positron emission tomography.
The
dollar amounts specified in subparagraphs (B), (F), and (H) of this
paragraph,
division (iii) of subparagraph (G) of this paragraph, and
of
and
in paragraph (7) of this Code section
shall be adjusted annually by an amount calculated by multiplying such dollar
amounts (as adjusted for the preceding year) by the annual percentage of change
in the composite construction index, or its successor or appropriate replacement
index, if any, published by the Bureau of the Census of the Department of
Commerce of the United States government for the preceding calendar year,
commencing on July 1,
1991
2008,
and on each anniversary thereafter of publication of the index. The department
shall immediately institute rule-making procedures to adopt such adjusted dollar
amounts. In calculating the dollar amounts of a proposed project for purposes of
subparagraphs (B), (F), and (H) of this
paragraph,
division (iii) of subparagraph (G) of this paragraph, and
of
and
in paragraph (7) of this Code section, the
costs of all items subject to review by this chapter and items not subject to
review by this chapter associated with and simultaneously developed or proposed
with the project shall be counted, except for the expenditure or commitment of
or incurring an obligation for the expenditure of funds to develop certificate
of need applications, studies, reports, schematics, preliminary plans and
specifications or working drawings, or to acquire sites."
SECTION
2.
Said
chapter is further amended by revising subsection (a) of Code Section 31-6-47,
relating to exemptions, as follows:
"(a)
Notwithstanding the other provisions of this chapter, this chapter shall not
apply to:
(1)
Infirmaries operated by educational institutions for the sole and exclusive
benefit of students, faculty members, officers, or employees
thereof;
(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;
(3)
Institutions operated exclusively by the federal government or by any of its
agencies;
(4)
Offices of private physicians or dentists whether for individual or group
practice, except as otherwise provided in
subparagraphs
(G) and
subparagraph
(H) of paragraph (14) of Code Section 31-6-2;
(5)
Christian Science sanatoriums operated or listed and certified by the First
Church of Christ Scientist, Boston, Massachusetts;
(6)
Site acquisitions for health care facilities or preparation or development costs
for such sites prior to the decision to file a certificate of need
application;
(7)
Expenditures related to adequate preparation and development of an application
for a certificate of need;
(8)
The commitment of funds conditioned upon the obtaining of a certificate of
need;
(9)
Expenditures for the acquisition of existing health care facilities by stock or
asset purchase, merger, consolidation, or other lawful means unless the
facilities are owned or operated by or on behalf of a:
(A)
Political subdivision of this state;
(B)
Combination of such political subdivisions; or
(C)
Hospital authority, as defined in Article 4 of Chapter 7 of this
title;
(9.1)
Expenditures for the restructuring of or for the acquisition by stock or asset
purchase, merger, consolidation, or other lawful means of an existing health
care facility which is owned or operated by or on behalf of any entity described
in subparagraph (A), (B), or (C) of paragraph (9) of this subsection only if
such restructuring or acquisition is made by any entity described in
subparagraph (A), (B), or (C) of paragraph (9) of this subsection;
(10)
Expenditures for the minor
renovation,
remodeling, or repair of a health care
facility, or parts thereof or services provided or equipment used therein, or
the
acquisition or replacement of equipment,
including, but not limited to,
magnetic
resonance imaging equipment, positron emission tomography,
and CT scanners;
(11)
Capital expenditures otherwise covered by this chapter required solely to
eliminate or prevent safety hazards as defined by federal, state, or local fire,
building, environmental, occupational health, or life safety codes or
regulations, to comply with licensing requirements of the Department of Human
Resources, or to comply with accreditation standards of the Joint Commission on
Accreditation of Hospitals;
(12)
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 Bureau of the Census of the Department of Commerce, of the
United States government, calculated from the date of approval of the
project;
(13)
Transfers from one health care facility to another such facility of major
medical equipment previously approved under or exempted from certificate of need
review, except where such transfer results in the institution of a new clinical
health service for which a certificate of need is required in the facility
acquiring said equipment, provided that such transfers are recorded at net book
value of the medical equipment as recorded on the books of the transferring
facility;
(14)
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;
(15)
Increases in the bed capacity of a hospital up to ten beds or 10 percent of
capacity, whichever is less, in any consecutive two-year period, in a hospital
that has maintained an overall occupancy rate greater than 85 percent for the
previous 12 month period;
and
(16)
Capital expenditures for a project otherwise requiring a certificate of need 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 of Community Health; and
(iv)
Has at least 45 percent 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 percent 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;
and
(17)
Freestanding ambulatory surgical centers, including, but not limited to, those
owned, operated, and utilized by physicians, including general
surgeons."
SECTION
3.
All
laws and parts of laws in conflict with this Act are repealed.