A Program Of The Georgia Department Of Community Health A SNAPSHOT OF GEORGIA Certificate Of Need Overview The Georgia Department of Community Health (DCH), Division of Health Planning (DHP) is responsible for administering the Certificate of Need Program (CON) that evaluates proposals for new or expanded health care services, or facilities under Georgia's Health Planning Statute, O.C.G.A. Title 31, Chapter 6. Major reforms to the statute were enacted during the 2008 Georgia Legislative Session with the passage of Senate Bill 433. This resulted in many new exceptions, new expenditure thresholds and expanded reporting requirements. Certificate of Need CON is the official determination that a new or expanded health care service or facility is needed in Georgia. The purpose of the CON program is to ensure the availability of adequate health care services to meet the needs of all Georgians, while safeguarding against the unnecessary duplication of services that perpetuate the costs of health care services. General Steps for Acquiring a Certificate of Need All CON applications fall into two categories: non-batched and batched. Both types require submission of a Notice of Intent 30 days prior to submitting an application. Non-batched applications are accepted throughout the year; batched applications are accepted during four designated time periods called "batching cycles." For further guidance for submitting applications pursuant to a particular batching cycle, see dch.georgia.gov/00/channel_ title/0,2094,31446711_32467034,00.html STEP 1 Submit a Notice of Intent 30 days prior to submitting the CON application STEP 2 An original and one copy of an application should be submitted along with a certified check for the appropriate filing fee PROJECTS THAT REQUIRE CON A ll public and private hospitals, including general, acute-care and specialized hospitals N ursing homes A mbulatory surgical services or obstetrical facilities H ome health agencies D iagnostic, treatment and rehabilitation centers (whether forprofit or not-for-profit) M ajor medical equipment purchases or leases (e.g. MRI, CT Scanners) that exceed the equipment threshold M ajor hospital renovations or other capital activities by any health care facility that exceed the capital expenditure threshold B efore a health care facility can offer a health care service, which was not provided on a regular basis during the previous 12-month period, or add additional beds STEP 3 In reviewing an application, the DHP will take into account the general considerations specified in Rule 111-2-2-.09 and the appropriate, service-specific standards and criteria, if applicable, set forth at Rule 111-2-2-.11 STEP 4 A project application is either approved or denied by the DHP. If the application is approved, an official CON and project evaluation analysis is provided to the applicant. If the project is denied, a denial letter and project evaluation analysis is provided to the applicant STEP 5 Following a favorable award of a CON from the DHP, the applicant has 12 months from the date of approval to implement the proposed project. Certificates awarded for the acquisition of equipment shall be effective for 12 months, by which date the applicant must be in possession of the equipment. For projects which require construction or renovation, the applicant has one year from the date of approval to demonstrate substantial performance in beginning the project 2 Peachtree Street, Atlanta, Ga 30303 w www.dch.georgia.gov January 2011 A Snapshot Of Certificate Of Need Post Approval Reporting Requirements All CON approved projects must comply with post-approval requirements. CON post-approval requirements and progress reporting forms are available Projects Exempted on DCH's Web site. An applicant may download the progress report to submit to DCH. Progress reports are required to document timely project from CON Review implementation and completion, as well as interim progress of 50 percent, completion and specific phase timetable completion. R epairs to a facility that fall below the CON review threshold Certificate of Need Appeals Process R eplacement of existing therapeutic or CON decisions may be appealed by: diagnostic equipment that received prior The applicant CON authorization A competing applicant P rojects that bring facilities into compliance A competing health care facility that notified the DHP in writing about its opposition to a proposed project on or before the 60th day of the review cycle and participated in the required Opposition Meeting The county or municipal government where the project would be located with licensing requirements, life safety codes or standards of the Joint Commission on Accreditation of Health Care Organizations C ost overruns that represent less than 10 percent of the previously approved capital expenditure and do not exceed the CON review threshold; all cost overruns under Sanctions for Failing to Comply with Certificate of Need $300,000 are exempt from review A hospital that maintains an occupancy rate Laws greater than 75 percent for the preceding The DHP may: 12-month period may increase its capacity Issue cease and desist mandates and/or seek court injunctions to halt violations, as well as impose graduated fines ranging from $5,000 per day up to 30 days, $10,000 per day from 31 days through 60 days, and $25,000 per day after 60 days for each day a violation to the CON rules and regulations exists Impose monetary penalties of up to $500 per day for failure to notify of the transfer of ownership of a health care facility within 45 days of the transaction Require a certain percentage of the adjusted gross revenue of a by 10 beds or 10 percent of its existing inventory (whichever is greater) every two years without a CON unless the cost associated with the increase exceeds the capital threshold. The hospital must submit a written request for determination regarding exemption under this provision, and the request must document the facility's monthby-month occupancy J oint Venture or Single Specialty Ambulatory facility or service to be devoted to the provision of indigent and Surgical Center, the establishment and charity care. A party may be assessed a monetary penalty of the development of which does not exceed the difference between the amount of indigent and charity care that was committed to be provided and that actually was provided Revoke a CON in whole or in part pursuant to notification to the CON holder and a hearing statutory dollar threshold applicable to such exempted facilities U nless otherwise specified in the Rules, all applicants seeking an exemption must provide prior notice to and receive written Additional Information approval from DHP for the exempted activity If you are not sure if a project requires a CON before implementation, From O.C.G.A. 31-6-47 correspondence should be sent to DHP to request an official Letter of Determination. The request should be made on the Letter of Determination form, which can be obtained at dch.georgia. gov. The form should also include as much information about the project as possible. There is a filing fee of $250 for a determination request. DHP will respond in writing. A determination about whether CON requirements apply to a specific project must be made in writing. For more information, go to: dch.georgia.gov/con.