08 LC 33
2430S
The
Senate Health and Human Services Committee offered the following substitute to
SB
433:
ADOPTED
ADOPTED
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 provide that certain
destination cancer hospitals are subject to certificate of need requirements; to
add a definition and revise a definition; to provide certain conditions relating
to certificates of need for new institutional health services; to provide that
skilled nursing facilities, intermediate care facilities, and intermingled
nursing facilities may be allowed to divide under certain conditions; to
provide considerations for qualification for issuance of certificates of need
relating to destination cancer hospitals; to provide considerations for skilled
nursing facilities, intermediate care facilities, and intermingled nursing
facilities to relocate; to provide for penalties for destination cancer
hospitals which fail to comply with minimum requirements; to exempt prisons and
other secure correctional institutions of the Department of Corrections and the
Department of Juvenile Justice from certificate of need requirements; 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 in Code Section 31-6-2, relating to
definitions, by adding a new paragraph and by revising paragraph (8) to read as
follows:
"(6.2)
'Destination cancer hospital' means an institution with a licensed bed capacity
of 50 or less which provides diagnostic, therapeutic, treatment, and
rehabilitative care services to cancer inpatients and outpatients, by or under
the supervision of physicians, and whose proposed annual patient base is
composed of a minimum of 65 percent of patients who reside outside of the State
of Georgia."
"(8)
'Health care facility' means hospitals;
destination
cancer 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."
SECTION
2.
Said
chapter is further amended in Code Section 31-6-40, relating to certificate of
need required for offering health care, by adding a new subsection to read as
follows:
"(e)
A certificate of need issued to a destination cancer hospital shall authorize
the beds and all new institutional health services of such destination cancer
hospital. As used in this subsection, the term 'new institutional health
service' shall have the same meaning provided for in paragraph (14) of Code
Section 31-6-2. Such destination cancer hospital shall not be required to apply
for or obtain additional certificates of need for new institutional health
services, and such new institutional health services offered by the destination
cancer hospital shall not be reviewed under any service specific need
methodology or rules except for those promulgated by the department for
destination cancer hospitals. After commencing operations, in order to add an
additional new institutional health service, a destination cancer hospital shall
apply for and obtain an additional certificate of need under the applicable
statutory provisions and any rules promulgated by the department for destination
cancer hospitals, and such applications shall only be granted if the patient
base of such destination cancer hospital is composed of at least 65 percent of
out-of-state patients for two consecutive years. If such destination cancer
hospital cannot show a patient base of a minimum of 65 percent from outside of
this state, then its application for any new institutional health service shall
be evaluated under the specific statutes and rules applicable to that particular
service. If such destination cancer hospital applies for a certificate of need
to add an additional new institutional health service before commencing
operations or completing two consecutive years of operation, such applicant may
rely on historical data from its affiliated entities, as set forth in paragraph
(2) of subsection (b.1) of Code Section 31-6-42. Because destination cancer
hospitals provide services primarily to out-of-state residents, the number of
beds, services, and equipment destination cancer hospitals use shall not be
counted as part of the department´s inventory when determining the need for
those items by other providers. Nothing in this Code section shall in any way
require a destination cancer hospital to obtain a certificate of need for any
purpose that is otherwise exempt from the certificate of need
requirement."
SECTION
3.
Said
chapter is further amended in Code Section 31-6-40.1, relating to acquisition of
health care facilities, penalty for failure to notify the department, limitation
on applications, agreement to care for indigent patients, and penalties, as
follows:
"31-6-40.1.
"31-6-40.1.
(a)
Any person who acquires a health care facility by stock or asset purchase,
merger, consolidation, or other lawful means shall notify the department of such
acquisition, the date thereof, and the name and address of the acquiring person.
Such notification shall be made in writing to the department within 45 days
following the
acquisition,
and the acquiring person may be fined by the department in the amount of $500.00
for each day that such notification is late. Such fine shall be paid into the
state treasury.
(b)
The department may limit the time periods during which it will accept
applications for the following health care facilities:
(1)
Skilled nursing facilities;
(2)
Intermediate care facilities; and
(3)
Home health agencies,
to
only such times after the department has determined there is an unmet need for
such facilities. The department shall make a determination as to whether or not
there is an unmet need for each type of facility at least every six months and
shall notify those requesting such notification of that
determination.
(c)
The department may require that any applicant for a certificate of need agree to
provide a specified amount of clinical health services to indigent patients as a
condition for the grant of a certificate of
need;
provided, however, that each facility granted a certificate of need by the
department as a destination cancer hospital shall be required to provide
uncompensated indigent or charity care for residents of Georgia which meets or
exceeds 3 percent of such destination cancer hospital´s annual adjusted
gross revenues. As used in this subsection, the term 'uncompensated indigent or
charity care' shall have the same meaning as in paragraph (6) of subsection (a)
of Code Section 31-6-40.2. A grantee or
successor in interest of a certificate of need or an authorization to operate
under this chapter which violates such an agreement, whether made before or
after July 1, 1991, shall be liable to the department for a monetary penalty in
the amount of the difference between the amount of services so agreed to be
provided and the amount actually provided. Any penalty so recovered shall be
paid into the state treasury.
(c.1)
A destination cancer hospital shall be fined $1,000,000.00 if less than 65
percent of patients to whom such facility provides service in a calendar year
reside outside this state. All revenues collected from any such fine shall be
dedicated and deposited by the department into the Indigent Care Trust Fund
created pursuant to Code Section 31-8-152.
(d)
Penalties authorized under this Code section shall be subject to the same
notices and hearing for the levy of fines under Code Section
31-6-45."
SECTION
4.
Said
chapter is further amended by revising subsection (a) of Code Section 31-6-41,
relating to the scope and term of validity of a certificate of need, as
follows:
"(a)
A certificate of need shall be valid only for the defined scope, location, cost,
service area, and person named in an application, as it may be amended, and as
such scope, location,
service
area, cost, and person are approved by the department, unless such certificate
of need owned by an existing health care facility is transferred to a person who
acquires such existing facility. In such case, the certificate of need shall be
valid for the person who acquires such a facility and for the scope, location,
cost, and service area approved by the department.
However, in
reviewing an application to relocate all or a portion of an existing skilled
nursing facility, intermediate care facility, or intermingled nursing facility,
the department may allow such facility to divide into two or more such
facilities if the department determines that the proposed division is
financially feasible and would be consistent with quality patient
care."
SECTION
5.
Said
chapter is further amended in Code Section 31-6-42, relating to qualification
for issue of certificate of need, by adding new subsections to read as
follows:
"(b.1)
In the case of applications for the construction, development, or establishment
of a destination cancer hospital, the applicable considerations as to the need
for such service shall not include paragraphs (1), (2), (3), (7), (8), (10),
(11), and (14) of subsection (a) of this Code section but shall
include:
(1)
Paragraphs (4), (5), (6), (9), (12), and (13) of subsection (a) of this Code
section;
(2)
That the proposed new destination cancer hospital can demonstrate, based on
historical data from the applicant or its affiliated entities, that its annual
patient base shall be composed of a minimum of 65 percent of patients who reside
outside of the State of Georgia;
(3)
That the proposed new destination cancer hospital states its intent to provide
uncompensated indigent or charity care which shall meet or exceed 3 percent of
its annual adjusted gross revenues. As used in this paragraph, 'uncompensated
indigent or charity care' shall have the same meaning as in paragraph (6) of
subsection (a) of Code Section 31-6-40.2;
(4)
That the proposed new destination cancer hospital shall conduct biomedical or
behavioral research projects or service development which is designed to meet a
national or regional need;
(5)
That the proposed new destination cancer hospital shall be reasonably
financially and physically accessible;
(6)
That the proposed new destination cancer hospital shall have a positive
relationship to the existing health care delivery system on a regional
basis;
(7)
That an applicant for a new destination cancer hospital shall document in its
application that the new facility is not predicted to be detrimental to existing
hospitals within the planning area. Such demonstration shall be made by
providing an analysis in such application that compares current and projected
changes in market share and payer mix for such applicant and such existing
hospitals within the planning area. Impact on an existing hospital shall be
determined to be adverse if, based on the utilization projected by the
applicant, such existing hospital would have a total decrease of 10 percent or
more in its average annual utilization, as measured by patient days for the two
most recent and available preceding calendar years of data; and
(8)
That the destination cancer hospital shall express its intent to participate in
medical staffing workforce development activities.
(b.2)
In the case of an application for a replacement skilled nursing facility,
intermediate care facility, or intermingled nursing facility at an alternate
location or locations from its existing location, the department shall review
the application solely under the general considerations set forth in the
department´s rules as promulgated pursuant to subsection (a) of this Code
section and shall not be subject to any service specific considerations
established by the department if the following conditions are met:
(1)
Such facility has received prior certificate of need review and approval or has
been deemed under previous provisions of this chapter to be exempt from
certificate of need review;
(2)
The alternate location of the replacement facility is within the same county as
the applicant facility; and
(3)
The replacement facility does not otherwise qualify as an expanded service
within the specific review considerations for skilled nursing facilities and
intermediate care facilities."
SECTION
6.
Said
chapter is further amended in subsection (a) of Code Section 31-6-47, relating
to exemptions from the certificate of need program, by striking the "and" at the
end of paragraph (15), by striking the period at the end of paragraph (16) and
replacing it with "; and", and by adding a new paragraph to read as
follows:
"(17)
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. This shall include correctional
institutions operated by private entities in this state which house inmates
under the Department of Corrections or the Department of Juvenile
Justice."
SECTION
7.
All
laws and parts of laws in conflict with this Act are repealed.