The Georgia Dept of Community Health-- Healthcare Facility Regulation ("HFR") is the omnibus Georgia agency responsibility for licensing of all healthcare facilities.
On the Georgia DCH website's facilities provider information page they list the types of facilities that they regulate or that are under their purview. There is a conspicuous absence of any application for alcohol rehab, which is a result of Georgia's statute §111-8-19:
(g) "Drugs" means any substance defined as a drug by federal or Georgia law or any other chemical substance which may be used in lieu of a drug to obtain similar effects, with the exception of alcohol and its derivative.
Therefore, the Georgia Dept of Community Health-Healthcare Facility Regulation has regulation oversight for drug treatment programs, and Psychiatric and Specialty Residential Treatment Facilities -- but not alcohol treatment as a stand-alone facility. This does not obviate the necessity for licensing under the Georgia DCSS-- which regulates the programs, qualifications and staffing--- not the physical facility.
 Georgia Department of Community Health- Healthcare Facility Regulation
The DBHDD sets the regulations, requirements, and qualifications for behavioral health providers. Rather than interfacing with the Georgia state workers and staff, all administrative functions have been assigned to Beacon Health Options (headquartered in Boston, MA), and is referred to within the DBHDD literature and descriptions as the "ASO", and the organization or arrangement under which the both operate seamlessly, is known as the "Georgia Collaborative".
The Georgia Collaborative ASO utilizes a Pre-Qualification determination process to review new applicants of behavioral health services. New applicants who meet the Pre-Qualifiers receive an invitation to complete and submit the Georgia Collaborative ASO Agency Application to the Collaborative. Existing DBHDD approved behavioral health providers may submit the Georgia Collaborative ASO Agency Application at any time throughout the year. Upon receipt of a complete application packet the Georgia Collaborative notifies the applicant to schedule a site visit with DBHDD.
After the completion of a successful site visit and application review, the Georgia Collaborative ASO will request the provider to complete and submit a DCH online application. If approved by DCH, DBHDD and the provider are notified of the approval and the Medicaid provider number. If denied by DCH, DBHDD and the provider are notified of the denial. The provider is advised of the appeal rights. Once the Medicaid number is assigned, DBHDD will issue the appropriate agreement to the provider to deliver the approved service(s). Once the agreement is signed and returned, DBHDD will notify the Georgia Collaborative ASO and the provider will be added to the Network and allowed to submit authorizations to deliver services to qualified individuals.
The DBHDD has contracted with Beacon Health Options, a private corporation, to act as the Georgia Collaborative's Administrative Services Organization (ASO), on behalf of DBHDD. The "ASO" accepts and reviews provider applications for the provision of behavioral health services delivered by all tiers of providers, see Community Behavioral Health Provider Network Structure, 01-199. The Georgia Collaborative ASO will manage the application process for providers seeking approval by the State of Georgia. Successful completion of the pre-qualification and the application enrollment process results in the Georgia Collaborative ASO and DBHDD requesting a review of the provider's application by the Department of Community Health (DCH). DCH holds the final decision regarding the approval or denial of an application and the issuance of a Medicaid provider number.
To be considered an approved DBHDD Behavioral Health provider all phases of the process must be successfully completed. Receipt of Letter of Intent (LOI) and/or Application and engagement in the review process does not imply approval as a DBHDD Behavioral Health provider.
The Georgia Collaborative ASO would be the point of contact in dealing with the various Georgia agencies and departments.
Application needs to be made when nearing readiness to begin operations, and would need certain key individuals in place... i.e.:
These are normally figurehead positions of key responsible personnel, and do not require physical presence, however for future availability commensurate with scaling-up responsibilities.
There are numerous contract consultants intimately knowledgeable and experienced with the licensing/credentialing process, who initially become involved in the start-up process, for varying fees. The process in Georgia is far more simplified and streamlined than in other more highly regulated states such as Florida and California. Additionally , certain county requirements such as zoning and business licensing, have already been met in our case.
This is a requirement for most hospitals and healthcare companies, however the scale of the proposed/anticipated alcohol & substance abuse treatment facility, falls below the statutory threshold and definitions, and will therefore be exempt. See below downloads section for the CONS downloadable form.
It is anticipated that the proposed residential rehab operation and facility, would first have to file the requisite Letter of Intent (LOI), and then, once acknowledged, the operator would then file a "Request for Determination" to establish the exemption from the CONS requirement-- for failing to meet the statutory minimum capital expenditure threshold.
Generally, these state licensing applications utilize the same information (and verification processes) as the Joint Commission or CARF, which are SRO's (self-regulatory organizations):
These are no ordinary paid-membership organizations-- they have very strict qualifying and compliance procedures. Being approved by one of these-- is the qualifying entry credentials into the industry.
If an applicant/operator for state licensing is already a member of either organization, the approval of an additional facility in Georgia can be fast-tracked, and such location approval would easily lay the groundwork, and for acceptance for expedited approval by the Georgia DCH- HFR.
Per DBHDD Accreditation & Standards Compliance for providers of BH --the Medicaid State Plan Amendment for Medicaid BH programs, accreditation is required for BH providers who participate in Medicaid BH programs. DBHDD also requires other BH providers to be accredited whether or not they are participating in Medicaid BH programs.
The provider is responsible for ensuring that all service types that the organization provides are properly accredited.
Approved Accrediting Bodies – The national accrediting organizations approved and recognized by DBHDD for BH services are the following:
• Commission on Accreditation of Rehabilitation Facilities (CARF)
• The Joint Commission (TJC)
Georgia Behavioral Health Application for New Providers (Georgia Collaborative ASO) (pdf)Download
ASAM Levels of Care - Detailed Descriptions of Qualifications & Requirements (pdf)Download
Georgia DBHDD Application & Manual to become a Provider of BH Service (pdf)Download
Joint Commission BHC Guide to Accreditation (pdf)Download
Georgia Collaborative Behavioral Health Provider Letter-of-Intent (pdf)Download
Behavioral Health Services Site Inspection Form (pdf)Download
Ga. Dept Community Health- Healthcare Facility Regulation Statute 111-8-19 Drug Treatment Programs (pdf)Download
Rules of Community Health GA Chap. 111-2-2 Certificate of Need (pdf)Download
Georgia Certificate of Need- Letter of Intent Form (pdf)Download
GA Clinical Health Care Facilities (16)-Definition Rules (pdf)Download
Georgia Certificate of Need- Request for Determination (pdf)Download
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.
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.
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 Office of Health Planning may:
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
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;
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:
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.
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.
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