Licensing & Credentialling

The Certificate of Need (CON) program is intended to achieve three goals: (1) to measure and define need, (2) to control costs, and (3) to guarantee access to healthcare services. Georgia began reviewing health care projects in 1975 under Section 1122 of the 1972 Social Security Act Amendments and Georgia's CON program was established by the General Assembly in 1979 (O.C.G.A. Title 31, Chapter 6). Additional information is available from the CON Fact Sheet and from the links below.

• CON Applications and Forms
  Applications and forms needed for Certificate of Need and related      programs.
• CON  Filing Requirements|
  Requirements for filing a Certificate of Need application.
• CON  Thresholds
  Dollar threshold amounts required under Certificate of Need.
• CON  Tracking Report
  Weekly report tracking Certificate of Need and other regulatory      activity.
• GAMap2Care
  Access to available healthcare and facility reporting information
• Health Planning/Certificate of Need Open Records      Request Form

Certificate of Need Overview 

The Georgia Department of Community Health(DCH), Office of Health Planning (Department) 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.Title31, 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 Certificate of Need Applications 

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, see www.dch.georgia.gov/con.

• 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 must be submitted along with a certified check for the appropriate filing fee.
• STEP 3: In reviewing an application, the Department 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 Rule111-2-2-.11.
• STEP4: A project application is either approved or denied by the Department. 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, 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 that require construction or renovation, the applicant has one year from the date of approval to demonstrate substantial performance in beginning the project. 

Post Approval Reporting Requirements All CON approved projects must comply with post-approval requirements. CON post-approval requirements and progress reporting forms are available on DCH’s Web site. An applicant may download the progress report to submit to DCH. Progress reports are required to document timely project implementation and completion, as well as interim progress of 50 percent, completion and specific phase timetable completion. Certificate of Need Appeals Process CON decisions may be appealed by: 

• The  applicant; 
• A   competing applicant in the same batching cycle;
• Any  competing healthcare facility that has notified the department prior to  its decision that such facility is opposed to the application before the Department;
• A county or municipal government in whose boundaries a proposed project will  be located Sanctioned for Failing to Comply with Certificate of Need Laws 

The Office of Health Planning may:

• 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 facility or service to be devoted to the provision of indigent and charity care. A  party may be assessed a monetary penalty of 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. 

Additional Information'

If you are not sure if a project requires a CON before implementation, correspondence should be sent to the Department to request an official Letter of Determination. The request should be made on the CON Request for Determination form, which can be obtained at www.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. The Department will respond in writing. A determination about whether CON requirements apply to a specific project must be made in writing.

Projects Exempt from CON

• Repairs  to a facility that fall below the CON review threshold
• Replacement      of existing therapeutic or diagnostic equipment that received prior CON      authorization
• Projects  that bring facilities into compliance with licensing requirements, life  safety codes or standards of the Joint Commission on Accreditation of  Health Care Organizations
• Cost 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 $300,000 are exempt from review
• A hospital that maintains an occupancy rate greater than 75 percent for the      preceding 12-month period may increase its capacity by 10 beds or 10 percent of its existing inventory (whichever is greater) every two years  without a CON. The hospital must submit a written request for  determination regarding exemption under this provision, and the request      must document the facility’s month-by-month occupancy
• Joint-Venture  or Single-Specialty Ambulatory Surgical Center, the establishment and development of which does not exceed the statutory      dollar threshold applicable to such exempt facilities
• Unless  otherwise specified in the Rules or Statute, all applicants seeking an      exemption must provide prior notice to and receive written approval from      the Department for the exempted activity From O.C.G.A. § 31-6-4

DISCUSSION OF CON REQUIREMENT SPECIFIC TO OUR PROPOSED OPERATION:

WHY THIS RULE IS NOT APPLICABLE TO HIDDEN CREEK RETREAT

RULES OF GEORGIA DEPARTMENT OF COMMUNITY HEALTH - 

HEALTH PLANNING CHAPTER 111-2-2 CERTIFICATE OF NEED

(1) "Acquisition of an existing health care facility"means to come into possession or control of a health care facility by purchase, gift, merger of corporations, lease, purchase of stock, inheritance, or by any other legal means.

Hidden Creek Recovery Programs and Hidden Creek Retreat are therefore exempt by statutory definition. The lodge has never, nor is it now, an existing health care facility. Only at such point that the structure is occupied and utilized as a rehab, and such use and location description licensed by the State of Georgia for such use as defined under §16 below, which it would  become recognized as a de facto health care facility.  It would then be subject to the necessity of applying for, or obtaining a CON if the anticipated capital expenditure exceeds the threshold amount established for such year of anticipated improvements or expansion. This will most likely become an issue or a necessity several years down the road, for the expansion of bed capacity by constructing additional bungalows, if such construction costs exceed the 7/1/2018 Capital Expenditures threshold amount of $ 3,068,601

 "Capital expenditure" in relation to a proposed modification, renovation, or addition to a health care facility or to a diagnostic, treatment, or rehabilitation center, or acquisition of equipment, means an expenditure by or on behalf of a health care facility or diagnostic, treatment, or rehabilitation center that, under generally accepted accounting principles, is not properly chargeable as an expense of operation or maintenance. Any series of capital expenditures, each less than a threshold, but which when taken together are in excess of a threshold, directed toward the accomplishment of a single project, requires a Certificate of Need. Any series of capital expenditures, which are associated and simultaneously developed or proposed, will be presumed to be a single project. In calculating the capital expenditure for modifications, additions, or renovations "capital expenditure" is the amount per construction bid or total amount of invoices or purchase orders for the single project excluding diagnostic or therapeutic equipment.(14) "Certificate of Need", as defined at O.C.G.A. § 31-6 -2(6), means an official determination by the Department, evidenced by certification issued pursuant to an application, that the action proposed in the application satisfies and complies with the criteria contained in the Statute and Rules promulgated pursuant thereto.(15) Reserved.(16) "Clinical health services", as defined at O.C.G.A. § 31-6-2(8), 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.

O.C.G.A. 31-6-40. Certificate of need required for new institutional health services; exemption

(2) Any expenditure by or on behalf of a health care facility in excess of $2.5 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. The dollar amounts specified in this paragraph and in subparagraph (A) of paragraph (14) of Code Section 31-6-2 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 index of construction material prices, or its successor or appropriate replacement index, if any, published by the United States Department of Commerce for the preceding calendar year, commencing on July 1, 2009, 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 this paragraph and subparagraph (A) of paragraph (14) of Code Section 31-6-2, 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;  

• (3) The purchase or lease by or on behalf of a health care facility or a diagnostic, treatment, or rehabilitation center of diagnostic or therapeutic equipment with a value in excess of $1 million; provided, however, that diagnostic or other imaging services that are not offered in a hospital or in the offices of an individual private physician or single group practice of physicians exclusively for use on patients of that physician or group practice shall be deemed to be a new institutional health service regardless of the cost of equipment; and provided, further, that this shall not include build out costs, as defined by the department, but shall include all functionally related equipment, software, and any warranty and services contract costs for the first five years. The acquisition of one or more items of functionally related diagnostic or therapeutic equipment shall be considered as one project. The dollar amount specified in this paragraph, in subparagraph (B) of paragraph (14) of Code Section 31-6-2, and in paragraph (10) of subsection (a) of Code Section 31-6-47 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 consumer price index, or its successor or appropriate replacement index, if any, published by the United States Department of Labor for the preceding calendar year, commencing on July 1, 2010;

Notices of Intent

Effective July 1, 2008, O.C.G.A. 31-6-40(b) provides that:

Any person proposing to develop or offer a new institutional health service or health care facility shall, before commencing such activity, submit a letter of intent and an application to the Department and obtain a certificate of need in the manner provided in this chapter unless such activity is excluded from the scope of this chapter. O.C.G.A. 31-6-43(a) further provides that:At least 30 days prior to submitting an application for a certificate of need for clinical health services, a person shall submit a letter of intent to the Department. The Department shall provide by rule a process for submitting letters of intent and a mechanism by which applications may be filed to compete with and be reviewed comparatively with proposals described in submitted letters of intent.

All parties interested in applying for a certificate of need for new institutional health services MUST NOW NOTIFY THE DEPARTMENT 30 DAYS PRIOR TO FILING AN APPLICATION of their intent to do so. This notice must be in writing and must contain the following information:

• Name and address of legal applicant;
• Person to whom inquiries may be addressed;
• Name, address of facility, if different from legal applicant;
• Proposed Project Site Location;
• Brief summary description of proposal;
• Proposed service area; and,
• Cost of the project.

The Department will not accept any notices of intent submitted by either telephone, facsimile or e-mail pursuant to Rule 111-2-2-.06(5).

Note: The Department will begin implementing the Letter of Intent requirement on July 15, 2008. Beginning with that date, no CON application will be accepted without a previously filed Letter of Intent. The CON application must be submitted no later than 30 days after the Letter of Intent has been received by the Department.

BATCHING REQUIREMENTS

The Department will be promulgating rules for services that will now be batched pursuant to O.C.G.A. 31-6-43(e) which states:

To allow the opportunity for comparative review of applications, the Department may provide by rule for applications for a certificate of need to be submitted on a timetable or batching cycle basis no less often than two times per calendar year for each clinical health service. Applications for services, facilities, or expenditures for which there is no specified batching cycle may be filed at any time. The requirements for Notices of Intent associated with designated Batching Cycles will be issued at the time of publication of the Batching Notice.