Rule 111-2-2-.03 - [Effective 1/13/2025] Exemptions from ReviewThe following shall not be subject to Certificate of Need review and shall be exempted from the provisions of these Rules regarding Certificate of Need Review except as otherwise provided:
(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, as determined in the sole discretion of the Department, whether for individual or group practice except as otherwise provided in Ga. Comp. R. & Regs. r. 111-2-2-.01(54) and Ga. Comp. R. & Regs. r. 111-2-2-.01(42)(f). Simple ownership of a facility by a practitioner or a group of practitioners of the healing arts does not, in and of itself, exempt such facility from the scope of these Rules. Seeking licensure of a place, building, or facility as a health care institution is inconsistent with an assertion that such place, building, or facility is being occupied exclusively as the office of private physicians or dentists. Therefore, any person who seeks licensure as a health care facility must secure a Certificate of Need if a new institutional health service is being offered or developed;(5) Religious, nonmedical health care institutions as defined in 42 U.S.C. Section 1395x(ss)(1), listed and certified by a national accrediting organization;(6) site acquisitions for health care facilities or preparation or development costs for such sites prior to filing 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) 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;(10) expenditures for the restructuring or acquisition of existing health care facilities by stock or asset purchase, merger, consolidation, or other lawful means;(11) the purchase of a closing hospital or of a hospital that has been closed for no more than twelve (12) months by a hospital in a contiguous county to repurpose the facility as a micro-hospital;(12) 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 of regulations, to comply with licensing requirements of the Healthcare Facility Regulation Division, or to comply with accreditation standards of the Joint Commission or another nationally recognized health care accreditation body;(13) all cost overruns are excluded from prior Certificate of Need review and approval(14) increases in the bed capacity of a hospital up to ten beds or twenty percent (20%) of capacity, whichever is greater, in any consecutive three-year period, in a hospital that has maintained an overall occupancy rate greater than sixty percent (60%) (exclusive of any skilled nursing units or comprehensive inpatient rehabilitation units) for the previous twelve (12) month period;(15) The acquisition, replacement, or repair of diagnostic therapeutic, or other imaging equipment by any health care facility in existence prior to July 1, 2024, that is not owned by a group practice of physicians or a hospital and that provides diagnostic imaging services so long as it does not result in the offering of any new clinical health services;(16) An expenditures for the minor or major repair of a health care facility or a facility that is exempt from the requirements of these Rules, parts thereof or services provided therein;(17) new institutional health services offered by or on behalf of a Health Maintenance Organization, or a health facility controlled, directly or indirectly, by a Health Maintenance Organization or a combination of Health Maintenance Organizations, provided specific and detailed documentation is provided to the Department that one of the following conditions are met: (a) that seventy-five percent (75%) of the patients who can reasonably be expected to use the service will be individuals enrolled in a Health Maintenance Organization certified by the State of Georgia;(b) that the service is needed by the Health Maintenance Organization in order to operate efficiently and economically and that it is not otherwise readily accessible to the Health Maintenance Organization because:1. existing similar services are not available under a contract of reasonable duration;2. full and equal staff privileges are not available in existing facilities; or3. arrangements with existing facilities are not administratively feasible;(18) 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 all the following conditions are met: (a) the hospital has a bed capacity of not more than fifty (50) beds;(b) the hospital is located in a county in which no other medical-surgical hospital is located;(c) the hospital has at any time been designated as a disproportionate share hospital by the Department;(d) the hospital has at least forty-five percent (45%) of its patient revenues derived from Medicare, Medicaid, or any combination thereof, for the immediately preceding three years;(e) the project has at least eighty percent (80%) of its capital expenditures financed by proceeds of a special purpose county sales and use tax imposed pursuant to Article 3 of Chapter 8 of Title 48;(f) the proposed replacement hospital is located within a five (5)-mile radius of and within the same county as the hospital's existing facility; and(g) the project does not result in any of the following:1. the offering of any new clinical health services;2. any increase in bed capacity;3. any redistribution of existing beds among existing clinical health services; and4. any increase in the capacity of existing clinical health services;(19) Expenditures for nonclinical projects, including parking lots, parking decks, and other parking facilities; computer systems, software, and other information technology; medical office buildings; administrative office space; conference rooms; education facilities; lobbies; common spaces; clinical staff lounges and sleep areas; waiting rooms; bathrooms; cafeterias; hallways; engineering facilities; mechanical systems; roofs; grounds; signage; family meeting or lounge areas; other nonclinical physical plant renovations or upgrades that do not result in new or expanded clinical health services; and state mental health facilities;(20) Life plan communities, provided that the skilled nursing component of the facility is for the exclusive use of residents of the life plan community and that a written exemption is obtained from the Department; provided, however, that new sheltered nursing home beds may be used on a limited basis by persons who are not residents of the life plan community for a period up to five years after the date of issuance of the initial nursing home license, but such beds shall not be eligible for Medicaid reimbursement. For the first year, the life plan community sheltered nursing facility may utilize not more than fifty percent (50%) of its licensed beds for patients who are not residents of the life plan community. In the second year of operation, the life plan community shall allow not more than forty percent (40%) of its licensed beds for new patients who are not residents of the life plan community. In the third year of operation, the life plan community shall allow not more than thirty percent (30%) of its licensed beds for new patients who are not residents of the life plan community. In the fourth year of operation, the life plan community shall allow not more than twenty percent (20%) of its licensed beds for new patients who are not residents of the life plan community. In the fifth year of operation, the life plan community shall allow not more than ten percent (10%) of its licensed beds for new patients who are not residents of the life plan community. At no time during the first five (5) years shall the life plan community sheltered nursing facility occupy more than fifty percent (50%) of its licensed beds with patients who are not residents under contract with the life plan community. At the end of the five (5) year period, the life plan community sheltered nursing facility shall be utilized exclusively by residents of the life plan community and at no time shall a resident of a life plan community be denied access to the sheltered nursing facility. At no time shall any existing patient be forced to leave the life plan community to comply with this paragraph. The Department is authorized to promulgate rules and regulations regarding the use and definition of the term "sheltered nursing facility" in a manner consistent with Code section. Agreements to provide continuing care include agreements to provide care for any duration, including agreements that are terminable by either party;(21) Any single specialty ambulatory surgical center that:(a)1. Has capital expenditures associated with the construction, development, or other establishment of the clinical health services which do not exceed $2.5 million; or2. Is the only single specialty ambulatory surgical center in the county owned by the group practice and has two (2) or fewer operating rooms; provided, however, that a center exempt pursuant to this paragraph shall be required to obtain a certificated of need in order to add any additional operating rooms;(b) Has a hospital affiliation agreement with a hospital within a reasonable distance from the facility or the medical staff at the center has admitting privileges or other acceptable documented arrangements with such hospital to ensure the necessary backup for the center for medical complications. The center shall have the capability to transfer a patient immediately to a hospital within a reasonable distance from the facility with adequate emergency room services. Hospitals shall not unreasonably deny a transfer agreement or affiliation agreement to the center;(c)1. Provides care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids® beneficiaries and provides uncompensated indigent and charity care in an amount equal to or greater than two percent (2%) of its adjusted gross revenue, and on or after January 1, 2026, in an amount equal to or greater than the minimum amount established by the Department shall be reviewed by the Department every 12 months; or2. If the center is not a participant in Medicaid or the PeachCare for Kids® Program, provides uncompensated care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids® beneficiaries, uncompensated indigent and charity care, or both in an amount equal to or greater than four percent (4%) of its adjusted gross revenue, and on or after January 1, 2026, in an amount equal to or greater than the minimum amount established by the Department which shall be reviewed by the Department every 12 months; provided, however, single specialty ambulatory surgical centers owned by physicians in the practice of ophthalmology shall not be required to comply with this subparagraph; and(d) Provides annual reports in the same manner and in accordance with O.C.G.A. § 31-6-70. Noncompliance with any condition of this paragraph shall result in a monetary penalty in the amount of the difference between the services which the center is required to provide and the amount actually provided and may be subject to revocation of its exemption status by the Department for repeated failure to pay any fines or moneys due to the Department or for repeated failure to produce data as required by O.C.G.A. § 31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the Georgia Administrative Procedure Act. The dollar amount specified in this paragraph shall be adjusted annually by an amount calculated by multiplying such dollar amount (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. In calculating the dollar amounts of a proposed project for purposes of this paragraph, the costs of all items subject to review by this chapter and items not subject to review by this chapter associated with an 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;
(22) Any joint venture ambulatory surgical center that:(a) Has capital expenditures associated with the construction, development, or other establishment of the clinical health service which do not exceed $5 million;(b)1. Provides care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids® beneficiaries and provides uncompensated indigent and charity care in an amount equal to or greater than two percent (2%) of its adjusted gross revenue, and on or after January 1, 2026, in the amount equal to or greater than the minimum amount established by the Department, which shall be reviewed by the Department every 12 months; or2. If the center is not a participant in Medicaid or the PeachCare for Kids® Program, provides uncompensated care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids® beneficiaries, uncompensated indigent and charity care, or both in an amount equal to or greater than four percent (4%) of its adjusted gross revenue, and on and after January 1, 2026, in an amount equal to or greater than the minimum amount established by the Department which shall be reviewed by the Department every 12 months; and(c) Provides annual reports in the same manner and in accordance with O.C.G.A. § 31-6-70. Noncompliance with any condition of this paragraph shall result in a monetary penalty in the amount of the difference between the services which the center is required to provide and the amount actually provided and may be subject to revocation of its exemption status by the Department for repeated failure to pay any fines or moneys due to the Department or for repeated failure to produce data as required by O.C.G.A. § 31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the Georgia Administrative Procedure Act. The dollar amount specified in this paragraph shall be adjusted annually by an amount calculated by multiplying such dollar amount (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. In calculating the dollar amounts of a proposed project for purposes of this paragraph, 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;(23) Expansion of services by an imaging center based on a population needs methodology taking into consideration whether the population residing in the area served by the imaging center has a need for expanded services, as determined by the Department in accordance with its rules and regulations, if such imaging center:(a) Was in existence and operational in this state on January 1, 2008;(b) Is owned by a hospital or by a physician or a group of physicians comprising at least eighty percent (80%) ownership who are currently board certified in radiology;(c) Provides three (3) or more diagnostic and other imaging services;(d) Accepts all patients regardless of ability to pay; and(e) Provides uncompensated indigent and charity care in an amount equal to or greater than the amount of such care provided by the geographically closest general acute care hospital; provided, however, this paragraph shall not apply to an imaging center in a rural county;(24) Diagnostic cardiac catheterization in a hospital setting on patients fifteen (15) years of age and older;(25) Therapeutic cardiac catheterization in hospitals meeting the following criteria: A hospital that wishes to receive authorization to perform therapeutic cardiac catheterization procedures must:
1. submit a request for a letter of determination on the required form with the proper filing fee between May 1 and May 15 of each year, beginning with calendar year 2009; the sufficiency of the information submitted in the request shall be determined within the administrative discretion of the Department;2. provide documentation which demonstrates it can perform a minimum of two hundred (200) percutaneous cardiac interventions (PCI) per year by the beginning of the third year of operation of a program, including both elective and primary PCI, with a minimum of thirty-six (36) primary PCI per year beginning the third year of operation;3. provide documentation to support the criteria referenced in subsection 2 above that includes substantive information on the number of diagnostic cardiac catheterization procedures performed at the hospital, or referred to existing PCI providers by the hospital, in or out of the state of Georgia, in the two (2) calendar years immediately preceding the request;4. provide documentation that it will have, prior to beginning a PCI program, on active medical staff, at least one (1) interventional cardiologist who will meet the American College of Cardiology (ACC) and American Heart Association (AHA) competency standards, including the performance of at least seventy-five (75) PCI procedures per year;5. provide documentation that the interventional cardiologist is board certified, or is in the process at the time of the request, of obtaining board certification in Interventional Cardiology from the American Board of Internal Medicine;6. provide documentation of access to at least one (1) other interventional cardiologist who meets the criteria of subsections 4. and 5. above, to participate in its program on an as-needed basis as determined by the hospital;7. agree to report annually the data on number of PCI procedures, type, and outcomes to the National Cardiovascular Data Registry Cath/PCI registry;8. provide documentation to show that one (1) or more interventional cardiologist(s), as qualified in subsections 4., 5. and 6. above, are available to perform primary PCI procedures twenty-four (24) hours a day, seven (7) days a week, three hundred sixty-five (365) days a year;9. provide documentation one (1) or more interventional cardiologist(s) are required to respond to a call, within the calendar availability specified in subsection 8. above, within sixty (60) minutes;10. provide documentation that competent and trained nursing and technical cardiac catheterization staff are available at all times and are required to respond in a manner determined by the hospital in conjunction with the interventional cardiologists;11. provide documentation of a transfer agreement with a tertiary medical facility that has an open heart surgery service to which a patient can be transferred when necessary within a period of sixty (60) minutes, by any means of transportation as chosen by the hospital, from the time the need for transfer is identified; (i) if the provider of an open heart surgery service within the travel time parameters of this subsection refuses to enter into a transfer agreement with the requesting hospital, the hospital may submit documentation on the reasons given for the denial, and the Department may consider these reasons;(ii) the Department may allow a requesting hospital to submit a transfer agreement with a provider of an open heart surgery service that is beyond the travel time parameters in this subsection if the reasons given for the denial of a transfer agreement by the tertiary provider are determined by the Department to be unreasonable;(iii) if the Department determines the reasons for the denial of a transfer agreement by the tertiary provider within the time travel parameters in this subsection are reasonable, the Department may require the requesting hospital to address the reasons for the denial and enter into further negotiations for a transfer agreement prior to receiving a favorable determination from the Department;12. provide documentation of an agreement with an ambulance service capable of advanced life support and intra aortic balloon pump services and that guarantees a thirty (30) minute or less response time;13. agree to provide accurate and timely data, including outcomes analysis and formal periodic external and internal case review as required by the Department;14. provide documentation to show that guidelines for determining patients appropriate for PCI procedures in a setting without on-site open heart backup consistent with C-PORT and ACC standards will be developed and maintained;15. provide documentation to show the cardiac catheterization laboratory(s) at the requesting hospital is equipped in a manner consistent with C-PORT and ACC guidelines;16. agree to participate in an elective and primary PCI Development Program at its expense, the successful completion of which will be verified by the Department through the use of an identified third-party; and17. affirmatively agree authorization to begin a therapeutic cardiac catheterization program is expressly contingent upon successful completion of the development program as referenced in subsection 16. above.18. no hospital shall unreasonably deny a transfer agreement with another hospital. (b) Any hospital approved to perform therapeutic cardiac catheterization procedures as a result of a request submitted between May 1 and May 15 of any calendar year after the adoption of this rule, must, between May 1 and May 15, of each subsequent year, submit a request which documents its compliance with the standards of this Rule, and the Department must re-affirm the hospital's current compliance in writing in order for the hospital to continue its therapeutic cardiac catheterization program.(c) Any administrative proceeding held pursuant to Ga. Comp. R. & Regs. r. 111-2-2-.10(6), in opposition to a Department approval of a request from a hospital to perform therapeutic cardiac catheterization procedures in accordance with the standards established in this section, or in opposition to a Department decision to deny a hospital request to perform therapeutic cardiac catheterization procedures, shall not conduct a de novo review of the Department decision, and such decision shall only be reversed by an administrative hearing officer upon a showing the Department's action was without reason, arbitrary, or capricious;(26) Infirmaries for 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, including correctional institutions operated by private entities in this state which house inmates under the Department of Corrections or the Department of Juvenile Justice;(27) The relocation of any skilled nursing facility, intermediate care facility, or micro-hospital within the same county, any other health care facility in a rural county within the same county, and any other health care facility in an urban county within a five-mile radius of the existing facility so long as the facility does not propose to offer any new or expanded clinical health services at the new location;(28) Facilities which are devoted to the provision of treatment and rehabilitative care for periods continuing for twenty-four (24) hours or longer for persons who have traumatic brain injury, as defined in O.C.G.A. § 37-3-1;(29) The renovation, remodeling, refurbishment, or upgrading of a health care facility, so long as the project does not result in any of the following:(a) The offering of any new or expanded clinical health services;(b) Any increase in inpatient bed capacity;(c) Any redistribution of existing beds among existing clinical health services; or(30) The acquisition of diagnostic, therapeutic, or other imaging equipment, by or on behalf of: (b) An individual private physician or single group practice of physicians exclusively for use on patients of such private physician or single group practice of physicians and such private physician or member of such single group practice of physicians is physically present at the practice location where the diagnostic or other imaging equipment is located at least seventy-five percent (75%) of the time that the equipment is in use.(31) Any capital expenditures by a hospital at such hospital's primary campus for: (a) The expansion or addition of the following clinical health services: operating rooms, other than dedicated outpatient operating rooms; medical-surgical services; gynecology; procedure rooms; intensive care; pharmaceutical services; pediatrics; cardiac care or other general hospital services; provided, however, that such expenditure does not include the expansion or addition of inpatient beds or the conversion of one type of inpatient bed to another type of inpatient bed; or(b) The movement of clinical health services from one location on the hospital's primary campus to another location on such hospital's primary campus. Pursuant to O.C.G.A. § 31-6-40(c)(1), any person who had a valid exemption granted or approved by the former Health Planning Agency or the Department of Community Health prior to July 1, 2008, shall not be required to obtain a Certificate of Need in order to continue to offer those previously offered services.
(32) New or expanded psychiatric or substance abuse inpatient programs or state funded beds that serve Medicaid and uninsured patients that:(a) Are open 365 days per year, seven days per week, and 24 hours per day;(b) Provide uncompensated indigent and charity care in an amount equal to or greater than 3 percent of its adjusted gross revenue, and on and after January 1, 2026, in an amount equal to or greater than the minimum amount established by the department by rule which shall be at least 3 percent, and which shall be reviewed by the department every 12 months;(c) Participate as providers of medical assistance for Medicaid purposes;(d) Have hospital affiliation agreements with acute care hospitals within a reasonable distance from the programs or state funded beds or the medical staffs at the programs or state funded beds have admitting privileges or other acceptable documented arrangements with such hospitals to ensure the necessary backup for the programs or state funded beds for medical complications. The programs or state funded beds shall have the capability to transfer a patient immediately to a hospital within a reasonable distance from the programs or state funded beds with adequate emergency room services. Acute care hospitals shall not unreasonably deny a transfer agreement or affiliation agreement with the programs or state funded beds;(e) Provide annual reports in the same manner as in accordance with Code Section 31-6-70Noncompliance with any condition of this subsection shall result in a monetary penalty in the amount of the difference between the services which the exemption holder is required to provide and the amount actually provided and shall be subject to revocation of its exemption status by the Department for repeated failure to meet any one or more requirements for exemption, for repeated failure to pay any fines or moneys due to the Department, or for repeated failure to produce data as required by Code Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act." "Expanded" means exceeding a health car facility's total approved inpatient bed capacity through the addition of beds to an existing CON-authorized or exempt or grandfathered freestanding psychiatric and/or substance abuse hospital.
(33) The offering of new or expanded basic perinatal services, as defined in Ga. Comp. R. & Regs. r. 111-2-2-.24(2)(a), by a hospital in a rural county, as defined at Ga. Comp. R. & Regs. r. 111-2-2-.24(2)(k) provided that: (a) Such services are available 365 days per year, seven days per week, and 24 hours per day;(b) The hospital participates as a provider of medical assistance for Medicaid purposes;(c) The hospital has a hospital affiliation agreement with an acute care hospital with at least Level III perinatal services, as defined in Ga. Comp. R. & Regs. r. 111-2-2-.24(2)(c), within a reasonable distance from the hospital providing the perinatal services or the medical staff at the hospital providing the perinatal services has admitting privileges or other acceptable documented arrangements with such acute care hospital to ensure the necessary backup for the hospital providing the perinatal services for medical complications. The hospital providing the perinatal services shall have the capability to transfer a patient immediately to the acute care hospital within a reasonable distance from the hospital providing the perinatal services with adequate emergency room services. Acute care hospitals shall not unreasonably deny a transfer agreement or affiliation agreement with the hospital providing the perinatal services. This subparagraph shall not apply if the hospital providing the basic perinatal services is itself an acute care hospital with at least Level III perinatal services; and(d) Provides annual reports in the same manner and in accordance with Code Section 31-6-70; Noncompliance with any condition of this subsection shall result in a monetary penalty in the amount of the difference between the services which the exemption holder is required to provide and the amount actually provided and shall be subject to revocation of its exemption status by the Department for repeated failure to meet any one or more requirements for the exemption, for repeated failure to pay any fines or moneys due to the Department, or for repeated failure to produce data as required by ode Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedures Act."
(33.1) Any new or expanded building or facility where human births occur on a regular and ongoing basis and which is classified as a birthing center pursuant to Ga. Comp. R. & Regs. r. 111-8-7 et seq., provided that: (a) Services are available 365 days per year, seven days per week, and 24 hours per day;(b) The birthing center participates as a provider of medical assistance for Medicaid purposes;(c) The birthing center has a hospital affiliation agreement with an acute care hospital with at least Level III perinatal services within a reasonable distance from the birthing center or the medical staff at the birthing center has admitting privileges or other acceptable documented or medical arrangements with such acute care hospital to ensure the necessary backup for the birthing center for medical complications. The birthing center shall have the capability to transfer a patient immediately to the acute care hospital within a reasonable distance from the birthing center. Acute care hospitals shall not unreasonably deny a transfer agreement or affiliation agreement with the birthing center;(d) The birthing center: 1. Provides basic perinatal services, as defined at Ga. Comp. R. & Regs. r. 111-2-2-.24(2)(a), which shall include but not be limited to a combination of such services as determined by the department;2. Meets the standards for certification established by the American Association of Birthing Centers, or equivalent or higher standards as determined by the department;3. Schedules routine visits and visits with other appropriate providers, as necessary, and tracks patients to verify that services have been received;4. Prior to 20 weeks gestation, certifies that a patient has been deemed to be a low risk patient, as defined by the department for purposes of this paragraph;5. Admits and provided services only to patients certified as low risk; and6. Refers patients to other appropriate providers if, at any point between the 20 weeks gestation certification and antepartum, the birthing center determines that a patient no longer qualifies as a low risk patient for any reason; and(e) The birthing center provides annual reports in the same manner and in accordance with Code Section 3-6-70;(f) For purposes of this exemption, "expanded" means any capital renovation or construction project which results in the addition of a birth room as defined at Ga. Comp. R. & Regs. r. 111-8-7-.01(c). Noncompliance with any condition of this subsection shall result in a monetary penalty in the amount of the difference between the services which the exemption holder is required to provide and the amount actually provided and shall be subject to revocation of its exemption status by the Department for repeated failure to meet any one or more requirements for the exemption, for repeated failure to pay any fines or moneys due to the Department, or for repeated failure to produce data as required by Code Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of the Title 50, the "Georgia Administrative Procedure Act."(34) A new general acute care hospital in a rural county, as defined at Ga. Comp. R. & Regs. r. 111-2-2-.20(2)(l) that:(a)1. Attains status as a teaching hospital, as defined in Ga. Comp. R. & Regs. r. 111-2-2-.20(2)(p) withing 36 months of opening, and maintains such status thereafter; or2. Obtains verification as a Level I, II, III, or IV trauma center from the American College of Surgeons within 36 months of opening, and maintains such verification thereafter;(b) Provides emergency, inpatient, and outpatient psychiatric and behavioral health services;(c) Has an emergency department that is open 365 days per year, seven days per week, and 24 hours per day;(d) Provides uncompensated indigent and charity care in an amount equal to or greater than 3 percent of its adjusted gross revenue, and on and after January 1, 2026, in an amount equal to or greater than the minimum amount established by the department by rule which shall be no less than 3 percent and which shall be reviewed by the department every 12 months;(e) Participates as a provider of medical assistance for Medicaid purposes; and(f) Provides annual reports in the same manner and in accordance with Code Section 31-6-70; Noncompliance with any condition if this subsection shall result in a monetary penalty in the amount of the difference between the services which the exemption holder is required to provide and the amount actually provided and ball be subject to revocation of its exemption status by the Department for repeated failure to meet any one or more requirements for the exemption, for repeated failure to pay any fines or moneys due to the Department, or for repeated failure to produce data as required by Code Section 3-6-70 after the exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act."
(35) A new acute care hospital where a short-stay general hospital in a rural county, as defined at Ga. Comp. R. & Regs., R. 111-2-2-.20(2)(i), has been closed for more than 12 months and a new replacement hospital has not opened that: (a) Is locates in the same rural county where the short-stay general hospital was closed;(b) Has no more than the number of licensed beds that were previously licensed in the closed hospital;(c) Has an emergency department that is open 365 days per year, seven days per week, and 24 hours per day;(d) Providers all required clinical health services as generally offered by a short-stay general hospital to meet licensure requirements pursuant to Ga. Comp. R. & Regs. r. 111-8-40 et seq.; and(e) Providers uncompensated indigent and charity care in an amount equal to or greater than 3 percent of its adjusted gross revenue, and on and after January 1, 2026, in an amount equal to or greater than the minimum amount established by the department by rule which shall be no less than 3 percent and which shall be reviewed by the department every 12 months. Such acute care hospital may provide basic perinatal services as defined at Ga. Comp. R. & Regs. 111-2-2-.24(2)(a);
(36) A new short-stay general hospital to address the underserved population previously served by a short-stay general hospital that was closed within the 48 months preceding the filing of a request for a letter of determination that: 1. Is located within a county with a population of more than 1 million according to the United States decennial census of 2020 or any future such census:2. Is located within five miles of and in the same county as the main campus of a medical school that is accredited by the Liaison Committee on Medical Education to confer Doctor of Medicine (M.D.) degrees;3. Has in place at the time of filing of a request for a letter of determination a written agreement to serve as a teaching hospital, as defined at Ga. Comp. R. & Regs. r. 111-2-2-.20(2)(p), for students of the medical school described in division (ii) of this paragraph;4. Has a maximum number of short-stay general hospital beds not greater that 50 percent of the maximum number of short-stay general hospital beds for which the closed short-stay general hospital had previously been licensed at any time during the 12 months prior to its closure;5. Has an emergency Department that is open 365 days per year, seven days per week, and 24 hours per day; and6. Provides uncompensated indigent and charity care in an amount equal to or greater than 3 percent of its adjusted gross revenue, and on and after January 1, 2026, in an amount equal to or greater than the minimum amount established by the department by rule which shall be no less than 3 percent and which shall be reviewed by the Department every 12 months; (b) An exemption for a new short-stay general hospital under this subsection shall include an exemption for all clinical services and equipment generally utilized at an acute care short-stay general hospital and required for licensure, including, but not limited to, an emergency department; Level II perinatal/neonatal services, including labor, delivery, recovery, and Level II neonatal intermediate care services; diagnostic imaging services; and surgical services; and(c) For a period of ten years following the issuance of its original license, a new short-stay general hospital approved for an exemption pursuant to this subsection shall be entitled to one or more determinations from the department to add additional short-stay general hospital beds, so long as the total licensed capacity of such hospital does not exceed the maximum number of short-stay general hospital beds for which the closed short-stay general had previously been licensed at any time during the 12 months prior to its closure; and(37) Transfer of existing beds from one general acute care hospital's primary campus to another general acute care hospital's primary campus within the same hospital system within a 15-mile radius of the original campus, provided that all of the following are satisfied:(a) Both hospitals involved in the transfer are general acute care hospitals and neither is a specialty hospital;(b) Both hospitals involved in the transfer are under common ownership or control;(c) The transferring hospital may not, for a period of 12 months after the transfer is effective, seek to expand the bed type which was transferred; and(d) The transferring hospital is open and operational at the time of transfer and shall not close within 12 months after the transfer is effective.(e) Written notice is provided to the Department within thirty (30) calendar days of the transfer confirming the number and types of beds transferred and that the transfer complies with all the requirements of this subsection.Ga. Comp. R. & Regs. R. 111-2-2-.03
O.C.G.A. §§ 31-2 et seq., 31-6 et seq.
Original Rule entitled "Exemptions from Review" adopted. F. Dec. 16, 2004; eff. Jan. 5, 2005.Amended: F. Sept. 11, 2008; eff. Oct. 1, 2008.Amended: F. May 1, 2009; eff. May 21, 2009.Amended: F. Oct. 19, 2018; eff. Nov. 8, 2018.Amended: F. Mar. 11, 2022; eff. Mar. 31, 2022.Note: Rule 111-2-2-.03, the incorrect version of the Rule was inadvertently filed (i.e., F. Mar. 11, 2022; eff. Mar. 31, 2022.) and appeared on the Rules and Regulations website April 28, 2022 through March 12, 2023. The correct version, as promulgated and adopted on March 10, 2022, was updated on the Rules and Regulations website March 13, 2023, the original filed and effective dates (i.e., F. Mar. 11, 2022; eff. Mar. 31, 2022.) were retained, as requested by the Agency. Effective March 10, 2023.Amended: F. Dec. 24, 2024; eff. Jan. 13, 2025.