FI RST DI VI SI ON

BA RNES, P. J.

, BROWN and HODGES, JJ.

N O T IC E : M otions for r e c ons i de r a tion m us t be

ph y sic a l ly r e ce iv ed i n our c le r k ’s offic e w ithin te n

da y s of the da te of de c is ion to be de e m ed tim e ly file d.

https ://w w w

. ga a ppe a ls .us /r ule s

June 29, 2022



# I n th e Co u r t o f

A p p eals o f

G eo r g ia

A2 2 A0 11 1

. EM ORY UNIVERSITY d / b / a EM ORY U NIVERSITY

HOSPITAL SM YRNA et al

. v

. KENNESTONE HOSPITAL,

INC. d / b / a W E LLSTAR W INDY HILL HOSPITAL.

A2 2 A0 11 2

. GEORGIA DEPARTM ENT OF COM M UN ITY

HEALTH v

. KENNESTONE HOSPITAL, INC. d/ b /a

W ELLSTAR W INDY HILL HOSPITAL.

H O D G E S , J u d g e.

In t h i s ap p eal

, we are as k ed t o d et erm in e w h et her an au t h o ri zed l o n g -t erm care

h o s p it al m ay co n v ert i t s bed s an d av ai l ab l e s erv ices t o o p erat e as a s h o rt -s tay g en eral

acu t e care h o s p i t al wi th o u t fi rs t o b t ai n i n g a n ew cert i fi cat e o f need ( “ C O N ”). See

OCGA § 3 1 -6 -4 0 et seq

. In 2 0 1 9

, Ken n es t o n e Ho s pi tal

, I n c. d / b / a W el lSt ar W i n dy

Hi l l Ho s p i t al ( “ We l l St ar”) s o u g h t co n fi rm at i o n fro m t h e Geo rg ia Dep art m en t o f

Co m m u n i t y Heal t h (“ t he DCH”) t hat i t s l o n g -t erm care h o s pi tal b ed s at i t s W i n d y Hi l l

Ho s pi t al faci l i t y “ wo u ld rev ert t o t h ei r p rev i o u s s t at u s as

. . . s h o rt -s t ay acu t e careb ed s” wi t h o u t o b t ai n i n g a CON o n ce t h e faci l i t y rel i n qu i s h ed i t s M ed icare lo n g -t erm

care h o s p i t al cert i fi cat i o n

. Em o ry U nive r sity d/b/a E m or y U nive r sity H ospital Sm

y rn a

a n d Sai n t J o s ep h ’ s Ho s p i t al o f At l an t a, In c. d /b / a Em ory Sai n t J o s ep h ’ s Ho s p i t a l

(co l l ect i v el y

, “ E m o ry ”) o bject ed t o W el l St ar’ s p ro p osa l, a r guing t ha t W e l l St ar s o u g ht

t o creat e a n ew s ho rt -s t ay acu te care g en eral h os p it al

, wh i ch req u i r e d p ri o r CON

au t h o ri zat i o n

. T h e DCH ag reed wi t h Em o ry

, fi n d i n g t h at W el l St ar h ad o p erat ed as a

l o n g -t erm care h o s p i t al s i n ce 19 9 6 an d

, as a res u l t

, h ad o bt ai ned vari o u s CONs d u ri n g

t h at s p an wh i ch d id n ot in v o l v e s h o rt -s t ay h o sp i t al b ed s

. Th u s

, t h e DCH d et erm i n ed

t h at W el l St ar’ s p ro p os ed t ran s i t i o n o f W i n dy Hi l l Ho s p i t al t o a 1 1 5 -b ed s h o rt -s t ay

h o s p i tal co n s t i t u t ed a “ n ew i n s t i t ut i o nal h eal t h s erv i ce,” w h i ch req u i re d C O N

ap p ro v al . See OCGA § 3 1 -6 -4 0 (a).

W el l St ar ap p eal ed t o th e CON Ap p eal Pan el

, an d a h eari n g o ffi cer affi rm ed t h e

DCH’ s d eci s i o n

. W el l St ar n ex t ap p eal ed to t h e DCH co m m is si o n er, wh o affi rm ed t h e

h eari n g o ffi cer. Ho wev er

, t h e S u p eri o r Co u rt o f Co b b Co u n t y g ran t ed W el l St ar’ s

p et i t i o n fo r ju d i ci al rev i ew an d rev ers ed t h e DCH co m m i s s i o n er’ s d eci si o n

, fi n d i n g

t h at W el l St ar “ i s en ti t l ed t o rev ert it s b ed s t o t h ei r p rev i o u s s ho rt -s tay s t at u s wi t h o ut

p ri o r CON rev iew an d ap p ro v al .”

2W e g ran t ed Em o ry an d t h e DCH’ s ap p l i cat io n s fo r d is cret i o n ary ap p eal

, an d

n o w co n cl u d e t h at

, b as ed u p o n t h e p l ai n lan g u ag e o f OCGA § 3 1 -6 -4 0 e t s e q

. , Ga

.

Co m p

. R. & Reg s

. r. 1 1 1 -2 -2 -.2 0 (1 ) (d ) an d 11 1 -2 -2 -.3 6 (2 ) (d ), W el l St ar’ s p ro p o s ed

co n vers io n o f i t s l o n g -t erm care h o s p i t al bed s t o s h o rt -t erm acu t e care h os p i t al b ed s

req u i res a n ew CON. Th erefo re, we rev ers e t h e s u peri o r co u rt ’ s ju d g m en t g ran t i n g

W el l St ar’ s p et it i o n fo r ju d i ci al rev i ew in Cas e No

. A2 2 A0 11 1 an d d i s m i s s Cas e No

.

A2 2 A0 11 2 , fi led b y

t h e DCH, as m o o t

.

1

. A t t he o ut s et

, w e d et erm i n e “ wh et h er ‘ s u bs t an ti al ev i d en ce’ s u p p o rt s t h e

ag en cy ’ s fi n di ng s of fact [.] ” Pa lmyr a Pa rk H os p

. v. Ph o eb e S

u mt er Med

. Cen t er

, 3 1 0

Ga. Ap p

. 48 7

, 4 8 8 (7 1 4 SE2 d 7 1 ) (2 0 1 1 ). In t hi s cas e, t h e o p erat i v e fact s a re

u n d i s p u t ed

. 1 So v iewed

, t h e reco rd d em on s trat es t h at W el l St ar W i n d y Hi l l Ho s p i t al

(“ W i n d y Hi l l ”) op en ed i n 1 97 3 as a g en eral acu t e care s h o rt -s t ay h o s p i t al b efo re

Geo rg i a en act ed i t s CON p ro gram

. 2 See OCGA § 3 1 -6 -4 0 et s eq

. In 1 9 83

, W in d y Hi l l

1 Th e p art i es ex ecu t ed a “ J o i n t St i p u l at io n o f Un d i s p u t ed Fact s ” d u ri n g

W el l St ar’ s ap p eal b efo re t h e CON A p p eal Pa n el

. Th e h eari n g o ffi cer in cl ud ed t h e

fact s i n t h e o ffi cer’ s o rd er affi rm i n g t h e DCH’ s i n it i al ag en cy d eci s i o n an d n o t ed t h at

t h e p art i es “ ag ree t h at t h ere are n o co n t es t ed i s s u es o f fact [,] ” a n d t h e DCH

co m m i s s io n er s p eci fi cal ly i n co rp o rat ed t h e s t i p u lat i o n i n h i s fi n al ord er affi rm i n g t h e

p an el d eci s i on

.

2 Th e CON Pro g ram b ecam e effect i v e i n 1 9 7 9. See Ga. Co d e An n

. § § 8 8 -3 3 0 1,

8 8 -3 30 6 (a) (1 9 8 3 ). “ Th e CON [ P] ro g ram es t ab l i s h es a co m preh en si ve s y s t em o f

3red u ced i t s s ho rt -s t ay b ed cap aci t y fro m 1 65 t o 1 1 5

. In 19 9 6, W el l St ar co n t act ed t h e

St at e Heal th Pl an n in g Ag en cy (“ t h e S H P A ”), t h e p red eces s o r ag en cy t o t he DCH,

i n q u i ri n g wh et h er a CON t o co n v ert W i n d y Hi l l fro m a s h o rt -s t ay g en eral acu t e care

h o s p i t a l t o a l o ng -t erm care h o s p i t al wo u l d b e req u i red

. In ad d i t io n t o p ro v i d i n g

l o n g -t erm care, W el l St ar rep res en t ed t hat it wo u l d pro v i d e o u t p at i en t s u rg i cal

s erv i ces an d co n v ert th e em erg en cy ro o m i n t o a m in o r em erg en cy

, o r i m m ed i at e care,

faci li t y

.

Bas ed o n W el lSt ar’ s rep res en tat i o n s

, t h e SHPA i s s u ed a d et erm i n at i o n l et t er

s t at i n g th at W el lSt ar wo u l d “ no t n eed t o o b t ai n CON ap p ro v al i n o rd er t o i m p l em en t

i t s p ro po s al ” b ecau s e t he o p erat i o n o f W i n d y H i l l “ as a lo n g-t erm acu t e care h o s p i t al

i s w i t hi n t h e o ri g i n al sco pe o f W i n d y Hi l l ’ s CON au th o ri z a t i o n as a g en eral acu t e

care h o s p i t a l

. ” Th ereaft er, W i n d y Hi l l s u rren d ered i t s o ri gi n al perm it

, wh i ch h ad

au t h o ri zed W i n d y Hi l l t o o p erat e as a “ Gen eral Ho sp i t al ,” an d t h e SHPA m ark ed t h e

p erm i t as “ Vo i d .” W el lSt ar o b t ai n ed a n ew p erm i t i n 1 9 9 7 au th o ri zi n g i t t o o p erat e

as a “ Sp eci al i zed Lo n g Term Acu t e Care Ho s pi tal ,” an d i t b eg an op erat i n g as a l o n g

t erm care h o s p i t al

. W i nd y Hi l l i n i t ial l y h ad 4 2 b ed s

, b ut i n 2 0 0 7

, W el l St ar o b t ai n ed

p l an n i n g fo r t h e o rd erl y d ev el o p m en t o f ad eq u at e h eal t h care s erv i ces t h ro u g h o u t t h e

s t at e.” P a l myr a Pa rk Ho s p

. , 3 1 0 Ga. Ap p . at 4 8 8

.

4a n ew CON t o ren o v at e t h e ho s p i t al i n o rd er t o ad d 5 ad d i t i o nal b ed s

. 3 Th ereaft er,

al t h o u g h W el l S t a r o n l y op erat ed 4 7 b ed s at W i n d y H i l l, t h e h o s p i t al ret ai n ed a

l i cen sed b ed cap aci t y

o f 1 1 5 b ed s

.

In 2 0 1 9

, W el l St ar s o u g ht a d et erm i n at i o n fro m t h e DCH t h at i t s co m

p l em en t

o f 1 1 5 l o n g -t erm b ed s w o u l d rev ert t o sh o rt -s t ay b ed s wi t h ou t g o i n g t h ro u g h CON

ap p ro v al

, an d th at i t wo u l d t h en h av e au t ho ri zat i o n t o o p erat e as a sh o rt -s t ay g en eral

acu t e care h o s p it al

, i f i t rel i n q u i s h ed i t s M ed i care l o n g -t erm c a r e h o s p i t al

c e r t i fi cat i o n

. In su p p o rt o f it s ap p l i cat i o n

, W el l St ar ci t ed Ga. Co m p

. R. & Reg s

. r.

1 1 1 -2 -2 -.2 0 (1 ) (d) a

nd 11 1 -2 -2 -.3 6 (2 ) (d ), wh i ch al l o w fo r t h e au t o m at i c co n v ers i o n,

o r rev ers io n

, o f cert ai n l o ng -t erm b ed s t o s h o rt -s t ay b ed s fo r h os p it al s t hat h av e b een

ap p ro v ed t h ro ug h t he CON p ro ces s.

Em o ry o b ject ed t o W el lSt ar’ s pro p o s al

, arg u i ng t h at W el l St ar s o u g h t t o creat e

a n ew s ho rt -s t ay h o s p i t al

, w h ich co n s t i t u t ed a “ n ew i n s ti t ut i o nal h eal th s erv i ce” an d

req u i red p ri o r CON ap p ro val

. In i t s i n i ti al ag en cy d e t e r m i n at i o n

, t h e D CH ag reed

3 Im p o rt an t l y

, th e d i s t i n ct i o n bet w e e n s h o rt -s tay acu t e care gen eral ho s p i tal s

an d l o n g -t erm care h o s p i t al s, wh i ch i s d i s cu s s ed i n g reat er d et ai l in fra, was

h i g h l i g h t ed by t h e p ro m

u lg at i o n o f Ga. Co m

p

. R. & Reg s

. r. 1 1 1 -2 -2 -.2 0 (“ Sp eci fi c

Rev iew Co n s i d erat i o n s fo r Sh o rt -s t ay Gen eral Ho s p i t al Bed s ” ) a n d 1 1 1 -2 -2 -.3 6

(“ Sp eci fi c Rev i ew Co n s id erat i o n s fo r L o n g T e r m Care Ho s p i tal s ”), each o f wh i ch

b ecam e effect iv e i n 2 0 0 5

.

5wi t h Em ory

, fi n d in g t h at W el l St ar h ad o p erat ed as a l o n g-t erm care faci l i t y s i nce

1 9 9 6 an d

, as s u ch

, h ad o b tai n ed v ari o u s C O N s w h i ch d i d n o t i n v ol v e s h o rt -s t ay

h o s p it al b ed s

. In ad d i t i o n, t h e DCH’ s d et erm i n at i o n n o t ed t h at t h e SHPA d et erm i n ed

i n 1 9 9 6 “ t h at W i n d y Hi ll ’s o p erat i ng as a [l o n g -t erm care h os p it al ] was n o t s u b ject

t o p ri o r C O N r ev i ew an d ap p ro v al .” Th us

, th e DCH d et erm i n ed th at W el l St ar’ s

p ro p os ed t ran s i t i o n t o a 1 1 5 -b ed sh o rt -s t a y ho s p i t al co n s t i t u t ed a n ew i n s t i t u t i o n al

h eal t h s erv i ce, wh i ch req u i red CON rev i ew an d ap pro v al

.

W el l St ar ap p eal ed th e DC H’ s i n i t ial d eci s i o n t o t h e CON A p p eal Pan el

, an d

a h eari n g o ffi cer affi rm ed t h e ag en cy ’ s d eci si on

. Th e h eari n g o ffi cer, ci t i n g G a.

Co m p

. R. & Reg s

. r. 1 1 1 -2

- 2

-

. 2 0 (1 ) (d ) an d 1 1 1-2 -2 -.3 6 (2 ) (d ), u p o n wh i ch

W el l St ar al s o rel i ed

, reject ed W el l S t ar’ s arg u m en t t h at i t was “ an ex i s t i n g g en eral

acu t e care h o s p i t al t h at was ap p ro v ed t h ro u g h t h e CON p ro ces s t o o p erat e as a [l o n g

t erm care ho s p i tal .] ” Th e heari n g o ffi cer co n cl u d ed t h at W el l S t a r h a d n o t g o n e

t h ro u g h t h e CON p ro ces s i n co n v ert i ng t o a l o n g -t erm care h os p it al

, i n s t ead fi n d i n g

t h at “ W i n d y Hi l l p erm i s s i b l y av o i d ed rat h er t h a n u nd erwen t

, m u ch l es s was

‘ ap p ro v ed t h ro u g h,’ a CON p ro ces s .” Th e h eari ng offi cer al s o det erm in ed t h at W i n dy

Hi l l h ad no t “ o ffered i np at i en t s h o rt -s t ay acu t e care s erv i c e s s i n ce i t co nv ert ed t o a

[l on g -t erm care ho s p i t al ]

. . . 2 3 y ears ag o” an d t h at “ [o ] perat i n g a sh o rt

- s t ay acu t e

6care faci l i t y o fferi n g su ch s erv ices w h ere no n e were o ffered o n a reg ul ar b as i s wi t h in

t h e prev i o u s 1 2 m on t h s w o ul d m ak e i t a ‘ n ew i n s t it u t i on al h eal t h s e r v i c e ’” t h at

req u i red CON rev i ew an d ap p ro v al

. Fi n al ly , t h e h eari n g o ffi cer reject ed W el l St ar’ s

arg u m en t t hat refu s i n g t o al l o w W i n d y Hi l l t o co n v ert i t s b ed s i n to s h o rt -s t ay acu t e

care b ed s v i o l at ed eq u al pro tect i o n b y t reat i n g i t d i fferen t l y t h an o t her l o n g -t erm care

h o s p it al s t h at co u l d rev ert b e d s t o s h o rt -t erm care b ed s. W el l St ar ap p eal ed t o t h e

DCH co m

m i s s io n er, wh o affi rm ed t h e heari n g o ffi cer. Th e co m m i s si o n er co n cl u d ed

t h at W i n d y Hi l l ’ s p ro p o s ed co n v ers i o n “ wo u l d res ul t in t h e o fferi n g o f a rev i ewab l e

n ew h eal t h serv i ce” t h at req u i r e d CON rev iew an d ap p ro v al

, an d t h at accep t i n g

W el l St ar’ s arg u m en t “ w o u l d res u l t i n a h o s p i tal ’ s bei n g ab l e t o fl i p back an d fo rt h [,] ”

t h ereb y u n d erm i n i n g t h e p u rp o s e o f t h e CON p ro g ram

.

W el l St ar t h en pet i t i o ned fo r ju di ci al rev i ew i n th e s up eri o r co u rt

. Fo l l o wi n g a

h eari n g

, t h e s u p er i o r co u rt rev ers ed t h e DCH co m m is s i o n er’ s d eci s io n

, co n cl u d i n g

t h at : (1 ) W el l St ar was en t i t l ed t o au t o m at ical l y rev ert i ts b ed s fro m l o n g -t erm care to

s h o rt -s t ay bed s u n d er Ga. Co m p

. R. & Reg s

. r. 1 1 1 -2 -2 -.2 0 (1 ) (d ) an d 1 1 -2 -2 -.3 6 (2 )

(d ) b ecau s e th e 1 99 6 l et t e r f ro m SHPA ack n o wl ed gi n g W el l St ar’ s ri g h t t o ch an g e

fro m a s h o rt -s tay h o s p i t al t o a l o n g -t erm care h o sp i t al co n s t i t u t ed a d et erm i n at i o n

u n d er t h e “ CON pro ces s” refe r e n c e d i n t h e Ru l es ; (2 ) W el l St ar was n o t o fferi n g a

7n ew in s t i t u t i on al heal t h s erv i ce req u i ri n g co m p l i an ce wi t h t h e CON p ro ced u re; an d

(3 ) W el l St ar was au t h o ri zed t o op erat e ei th er sh o rt -s t ay o r l o ng -t erm bed s

, an d t o t ak e

away o n e of t ho s e v es t ed ri g ht s wo u l d b e u n co n s t i t u t i o n al

. Fro m t hat o rd er, we

g ran t ed Em o ry a n d t h e DCH’ s ap p l i cat i on s fo r di s cret i on ary ap p eal

. W e co n s i d er

each ap p eal i n t urn , s t art i n g wi t h Em ory ’ s ap p eal

.

No

. A2 2 A 0 1 1 1

2

. Co n s id eri n g Em o ry ’ s fo u rt h en um erat io n f i rs t

, 4 Em o ry co nt en d s t h at t h e

s u p eri o r co u rt erred i n fi n d i n g th at W el lSt ar w en t t h ro u g h t h e CON p ro ces s i n 1 9 9 6

wh en i t co n v ert ed to a l o n g -t erm care ho s pi t al fro m a s ho rt -s t ay g e n e r a l a cu t e care

h o s p it al an d th at i t co ul d

, t h erefo re, t ak e ad v an t ag e o f cert ai n CON rev ers i o n

p ro ced ures . W e ag ree.

(i ) Gen er a l Pr i n ci

p l es

. “ Th e CON p ro g ram

, wh i ch is a d m in i s t ered b y t h e DCH,

es t ab l i s h es a s y st em o f m an dat o ry rev i ew req u i ri n g th at

, b efo re n ew i n s t i t u t i o n al

h eal t h s erv i ces an d faci l i ti es can b e d ev el o p ed

, th e d ev el o p er m u s t ap p l y fo r an d

recei v e a CON fro m t h e DCH.” (Ci t at i o n an d pu n ct uat i o n o m i tt ed

. ) Co bb Ho s p

., In c.

4 See Br o wn e & P r i ce, P.A. v. In n o va t i ve Eq u it y Co r p

., 36 1 Ga. Ap p

. 5 2 1

, 5 2 3

(1 ), n

. 7 (8 6 4 SE2 d 6 8 6 ) (2 0 2 1 ) (“ Fo r co n v en i en ce o f d i s cu s s io n

, w e h av e t ak en t h e

en u m erat ed erro rs o u t o f t he o rd er i n wh i ch ap p el lan t h as l is t ed t h em .”) (ci tat i o n an d

p u n ct u at i o n o m it t ed ).

8v. Dep t. o

f Co mmu n i ty Hea l t h

, 3 4 9 Ga. Ap p

. 4 5 2

, 4 56 (1 ) (a) (8 25 SE2 d 8 8 6 ) (2 0 1 9 ),

rev ers ed i n p a r t o n ot h er g ro u n d s

, 3 0 7 G a. 5 7 8 (8 3 7 SE2 d 3 7 1 ) (2 01 9 ); s ee al s o

OCGA § 3 1 -6 -1

. 5 Th e DCH i s al s o au t h ori zed t o p ro m ul g at e r u l e s f

o r t h e

ad m i n is t rat i o n o f t h e CON p ro gram

. See OCGA § 3 1 -6 -2 1 (a).

Th e l eg i s l at u re c ed es t h i s au t h o ri t y t o t h e DCH b ecau s e t he p u b li c i s

b et t er s erv ed b y h av i n g ex p ert s in t h e co m p l ex i t ies of h eal t h care

p l an n i n g m ak e t h es e d eci s i o n s

. T h e i s s ues are co m p l i cat ed

, an d t h e

ap p l icab l e l aws

, ru l es

, reg u l at i o n s

, an d p reced en ts req u ire m u ch s tu dy

,

es p eci al l y fo r a d eci s i o n -m ak er wh o i s n o t al read y fam i l i ar wi t h t h em

.

(Ci t at i o n o m i t t ed .) Co b b Ho s p ., 3 4 9 Ga. Ap p . at 4 56 (1 ) (a).

As a res u l t

, “ o n ap p e a l t o t hi s Co u rt

, o u r d u t y is no t to rev i ew wh et h er t h e

reco rd s u p p o rt s t h e s u p eri o r co urt ’ s d eci si o n b u t wh et h er t h e reco rd s u p p o rt s t h e fi n al

d eci s i o n o f t h e ad m in i s t rat i v e ag en cy .” (Ci t at i o n an d p u nct u at i o n o m i t t ed

. ) Ga

. Dep t

.

5 “ Th e po l i cy o f t h i s s t at e an d t h e p u rp o s es o f th i s ch ap t er are t o en s u re acces s

t o qu al i t y h eal t h care s erv i ces an d t o en s u re t h at heal t h care serv i ces an d faci l i t i es are

d ev el o p ed in an ord erl y an d eco n o m i cal m an n er an d are m ad e av ai l ab l e t o al l ci t i zen s

a n d t h at o n l y t h o s e heal t h care s erv i ces fo u n d t o b e i n t h e p u b l i c i nt eres t s h al l b e

p ro v id ed i n th i s s t at e. To ach i ev e s uch p u bl i c p o l i cy an d pu rp o s es

, i t i s es sen t i al t h at

ap p ro p ri at e heal t h pl an n i ng act i v it i es b e u n d ert ak en an d i m p l em en ted an d t h at a

s y s t em o f m an dat o ry rev i ew o f n ew i n st i tu t i o n al h eal t h s erv i ces b e p ro v i d ed

. Heal th

care s erv i ces an d faci l i t ies s h o u l d b e p ro v i d ed i n a m an n er t h at av o i d s u n n eces s ary

d u p l i cat i on of s erv i ces

, th at is co s t effect iv e, t hat p ro v i d es q u al i t y h eal t h care

s erv i ces

, an d th at i s co m

p at i b l e wi t h t h e h eal t h care n eed s o f t he v a r i o u s areas an d

p o p u l at i o n s o f t h e s t at e.” OCGA § 3 1 -6 -1

.

9o

f Co mmu n i t

y Hea l t h v. Sa t i l l a H

e a l t h S v c s

., 2 6 6 G a. Ap p

. 8 8 0

, 8 8 5 (1 ) (c) (5 9 8

SE2 d 5 1 4 ) (2 0 0 4 ). To th at en d

, we m ay rev ers e o r m od i fy t h e ag en cy ’ s d eci s i o n o n l y

i f t h e d eci s i o n i s :

(1 ) [i ] n v i o l at i o n o f co n s t i t u t io n al o r s t at ut o ry pro v i si o n s ; (2 ) [i ] n ex ces s

o f t h e s t at u t o ry au t h o ri t y o f t h e d ep art m en t ; (3 ) [m ] ad e u p o n u nl awfu l

p ro ced u res ; (4 ) [a] ffect ed b y o t h er erro r o f l aw; (5 ) [n ] o t s u p p o rt ed b y

s u b s t an t i al ev i d en ce, wh i ch s h al l m ean t h at t h e reco rd d o es no t co n t ai n

s u ch rel ev an t ev i d en ce as a reas on ab le m i n d m i g h t accep t as ad eq uat e

t o s u p p o rt s u ch fi nd i n g s, i nferen ces

, co n cl u s i o n s, o r d e c i s i o n s

, wh ich

s u ch ev id en t i ary s t an dard s h al l b e i n e x c es s o f t h e “ an y ev id en ce”

s t an dard co n t ai ned i n o th er s t at u t o ry pro v i s i on s ; o r (6 ) [a] rb i t rary o r

c a pr ic i o u s o r ch aract eri zed b y ab u s e o f d i s cret i o n o r cl earl y u nwarr a nte d

ex erci s e o f d i s cret i o n

.

OCGA § 3 1 -6 -4 4 .1 (a).

(i i) An a l ys i s

. Fo r t h e fo l l o wi n g reas o n s

, we c o n c l u d e th at t h e p lai n l an g u ag e

o f t h e rel ev an t ru l es an d s t at u t es co nfi rm s t h at W i n dy Hi l l is n ot “ a h o s p i t al t h at h as

b een ap p r o ved t hr o u g h t h e cer t i

f i ca t e o f n eed p r o ces s . . . .”

In i t s i n i t ial det erm i n at i o n l et t er, t h e DCH b ro ad l y s t at ed t h at “ W i n d y Hi l l ’ s

[Lo n g -Term Acu t e Care] Bed s W ere n o t Ap p ro v ed t h ro ug h t h e CON Pro ces s .” Th e

CON Ap p eal Pan el h eari n g o ff i cer ag reed

, fi n d i n g t h at W i n d y Hi l l “ p erm i s s i b l y

av o id ed rat h er t han u nd erwen t

, m u ch les s was ‘ ap p ro v ed t h ro u gh ,’ a CON p ro ces s ”

10i n 1 9 9 6

. As a res u l t, t h e h eari n g o ffi cer co n cl ud ed t hat W i n d y Hi ll ’ s l o n g-t erm care

h o s p it al b ed s di d n o t rev ert t o s h o rt -s t ay b ed s u n der G a. Co m p

. R. & Reg s

. r. 1 1 1 -2

-

2 -.2 0 (1 ) (d ) an d 11 1 -2 -2

-

. 3 6 ( 2 ) (d ) b ecau se W i nd y H i l l h ad n o t b een “ ap p ro v ed

t h ro u g h a CON p ro ces s [.] ” Th e DC H co m m i s s i o n er ag reed an d “ reject [ed ] W i n dy

Hi l l ’ s arg u m en t s t h at i t i s en t i t l ed t o av ai l i ts el f o f t h e ‘ rev ers i o n ex cep t i o n .’ ”

In co n t ras t, th e s u p eri o r co u rt fo u n d t h at W el l St ar was en t i t led t o h av e i t s l o n g

t erm care h o s p i t al b ed s au t o m at i cal l y rev ert t o s h o rt -s t a y b e d s u n d er G a. Co m p

. R.

& Reg s

. r. 1 1 1 -2 -2 -.2 0 (1 ) (d ) an d 1 1 1 -2 -2 -.3 6 (2 ) (d ). In su p p o rt of i t s ju dg m en t

, t h e

s u p eri o r co u rt fo u n d t hat W i n d y Hi l l was “ ap p ro v ed t h ro ug h t h e [CON] pro ces s ” in

1 9 9 6 w h en i t o bt ai n ed ap p ro v al fro m t h e DCH t o ch an ge fro m a g en eral care h o s p i t al

t o a l o n g -t erm h eal th faci l i ty wi t h ou t o b t ai n in g a CON.

(A) Rel eva n t

Ru l es Ap p l i ca b l e t o t h i s Ca s e . At t h e o u t s et

, we n o t e t h at wh en

ex am i n i n g s t at u t o ry

p ro vi s io ns

,

we ap pl y t h e fu n d am en t al ru les o f s t at u t o ry co n s t ru ct i o n t h at req ui re u s

t o co n s t ru e t he s t at ut e acco r d i n g t o i t s t erm s, t o g iv e wo rd s th ei r p l ai n

an d o rd in ary m ean in g

, an d t o av o i d a co ns t r u ct i o n t hat m ak es s o m e

l an g u ag e m ere s urp l u s ag e. Th u s

, a s t at u te s h o u l d be read acco rd i n g t o

i t s n at ural an d m o st o b v i o u s im p o rt of t he lan g u ag e wi t h o u t res o rt i n g t o

s u b t l e an d fo r c e d c o n s t ru ct i o n s fo r t h e p u rp os e o f ei t h er l i m i t i n g o r

ex t en d i n g i t s o p erat i o n

.

11(Ci t at i o n o m i t ted .) Co b b Ho s p

., 3 4 9 Ga. Ap p

. at 45 9 (1 ) (c) (i i ). “ Si m i l arl y

, in

c o n s t ru i n g ag en cy reg u l at i on s

, we em p l o y th e b as ic ru les o f s t at u t ory co n s t ru ct i o n

an d l o o k t o t h e p l ai n m ean i n g o f t h e reg ul at i o n to d et erm i n e i t s m ean i n g .” (Ci t at i o n

an d p u n ct u at i o n o m i t t ed .) Id . at 4 5 9 -4 6 0 (1 ) (c) (i i ).

Acco rd i ng l y

,

wh en an ad m in i s t rat i v e ag en cy d eci s i o n i s t h e s u b ject o f ju d i ci al rev i ew,

ju d i ci al d eferen ce i s t o b e affo rd ed t h e ag en cy ’ s i nt erp ret at i o n o f ru l es

a n d r e g u l at i o n s i t h as en act ed to fu l fi l l t h e fu n ct i o n g i ven i t by t h e

l eg i s l at i v e b ran ch

. An d i n co n s t ru i n g ad m i n i s t rat iv e ru l es

, t h e u l t i m at e

cri t eri o n i s t h e ad m i n i s t rat i v e i n t erp ret at io n

, wh i ch b eco m es o f

co n t ro ll i n g wei g h t u n l es s i t i s p l ai nl y erro n eo u s o r i n co n s i s t en t wi th th e

ru l e.

(Ci t at i o n an d p u n ct uat i o n o m it t ed .) A S M C

, L L C v. No r t h s i d

e Ho s p.

, 3 4 4 Ga. Ap p.

5 7 6

, 5 8 2 (8 1 0 SE 2 d 6 63 ) (2 0 1 8 ). In s h o rt

, we “ d efer t o t h e DCH’ s d eci s i on s

reg ard i n g p o l i cy

, as wel l as t o t h e DCH’ s i nt erp ret at i on an d en fo rcem en t o f i t s o wn

ru l es

. ” (Ci t at i o n s

, p u nct u at io n

, an d fo o t n o t e om i t t ed .) Co bb Ho s p

., 3 49 G a. Ap p

. at

4 6 0 (1 ) (c) (i i). Th i s i s s o b ecau s e

ag en ci es p ro v id e a h i g h l ev el o f ex p ert i s e an d an op p o r t u n i t y fo r

s p eci al i zat i o n u n av ai l ab l e i n t h e ju di ci al o r leg i s l at iv e br a n ch es

. Th ey

are ab l e t o u s e t h es e s k i l l s

, al o ng wi t h t h e p o li cy m an d at e an d d i scret i o n

en t ru s t ed t o t hem

b y t h e l eg is l at u re, t o m ak e ru l es an d en fo rce t h em i n

12fas h io n i n g s o l u t i o n s to v ery co m p l ex pr oble m s

. Th us

, t h ei r d eci s i o n s are

n o t t o b e t ak en l i g h tl y o r m i n i m i zed b y t he ju d i ci ary

. Rev i ew o v erb ro ad

i n s co p e wo u l d hav e t h e ef f e c t o f s u b s t i tu t i n g t h e ju d g m en t o f a j u d ge

o r j u r y f o r t h at o f t he ag en cy

, t h ereb y nu l l i fy in g t h e b en efi ts o f

l eg i s l at i v e d el eg at i o n t o a s p eci al ized b o d y

.

(Ci t at i o n an d p u nct u at i o n om i t t ed .) Id

. at 4 6 0 (1 ) (c) (i i). “ In t h e co n t ex t o f t h e DCH,

t h e ad m i n i st rat i o n of t h e CON p ro g ram req u i res a p art i cu l arl y h i g h lev el o f ex p ert i s e

an d s p eci al i zat i o n [b ecau s e] [t ] h e DCH ru les p ro m u l g at ed t o ad m i n i s t er t h e p ro g ram

are d et ai l ed an d l en g t h y .” (Ci t at i o n an d p u n ct u at i o n o m i t t ed .) Id

. at 4 6 0-4 6 1 (1 ) (c)

(i i).

(B) “ Cer t i

f i ca t e o f N e e d Pr o ces s .” Ag ai n s t t h is b ack d ro p

, we t u rn t o t h e

rel ev an t ru l es g o v ern i n g , an d a b as i c o v erv i ew o f, t h e CON p ro ces s

.

(1 ) Ga. Co m

p . R. & Reg s . r. 1 1 1 -2 -2 -.2 0 (1 ) (d ) p ro v i des t h at

a h o s p i t al t h at h as b een a p p r o ved t h r o u g h t h e Cer t i f ica t e o f N e e d

p r o ces s t o u s e a cert ai n n u m b er o f s h o rt -s tay h o s p i t al b ed s fo r lo ng -t erm

acu t e care (“ LTAC”) b ed s s h al l h av e s uch LTAC b ed s rem o v ed fro m th e

o ffi cia l i n ven t o ry of av ai l ab l e s h o rt -s t ay b ed s o n ce th e L TAC i s cert i fi ed

b y M ed icare; p ro v i d ed

, h o wev er, t h a t su ch b ed s wi l l r ever t t o th e

h o s p i t a l ’s of fi ci a l i n ven t o r

y o f a va i l a b l e s h or t -s t a

y b ed s a t a n y p o i n t

t h a t t h e LTAC cea s es o

p er a t i o n o r i s n o l o n g er

cer t i f i ed b y Med i ca r e

.

13(Em

p h as i s s up p l i ed .) Si m i l arl y

, Ga. Co m p. R. & Reg s

. r. 1 1 1 -2 -2 -.3 6 (2 ) (d ) p ro v i d es

t h at a “ Lo n g Term Care Ho s p i t al

, o r “ LTCH” i s :

a h o s p i tal th a t h a s b een a pp r oved th r o ug h t h e Cer t i fi ca te o f Need

p r o ces s to u s e al l o f i t s s h o rt -s t ay b ed s fo r a Frees t an d i n g L T CH sh al l

h av e s u ch b ed s rem o v ed fro m t h e o ffi ci al i n v e n to ry of av ai l ab l e

s h o r t -s t ay b ed s wh en t h e LTCH i s cert i fi ed b y Med i care; pro v i d ed

,

h o wev er, t h at t h e h o s

p i t a l ’s b ed

s wi l l r ever t t o t h e o

f f i ci al i n ven t o r

y o f

a va i la b l e s h or t -s t a

y b ed s a t a n y po i n t t h a t t h e fa ci li t

y cea s es t o be

cer t i f i ed b y Med i ca r e a s a n LTCH

.

(Em p h as i s s u p p l i ed .) Acco rd i n g l y

, t h es e p ro v i s io n s , wh i ch t h e DCH co m m i s s i o n er

an d t he part i es d ub b ed co l l ect i vel y as t h e “ rev ers i on ex cep t i o n s ,” are av ai l ab l e o n l y

t o t h o se ho s pi t al s t h at hav e b een “ ap p ro v ed t hro u g h th e cert i fi cat e o f n eed p ro ces s ”

t o u s e s h o rt -s t ay h o sp i t al b ed s i n a l o n g -t erm care h o s pi t al

. Ou r au t ho ri t i es m ak e cl ear

t h at W i n dy

Hi ll h as n o t b een s o ap p ro v ed

.

(2 ) W e h av e d es cri b ed th e CON p ro ces s as “ a s y s t em o f m an d at o ry rev i ew

req u i ri n g t h at

, b efo re n ew in s ti t u t i o n al h eal th serv i ces an d fac ilitie s c a n be de v el o p ed

,

t h e d ev el o p er m

us t ap p ly f

o r a n d r e c ei v e a CON fro m th e DCH.” A SMC

, 3 4 4 Ga.

Ap p . at 5 7 7 . As p art o f i ts ev al u at i o n

,

[t ] h e DCH rev i ews CON ap p l i cat i on s an d i ss u es d eci s io n s g ran ti n g o r

d en y i n g a CON u nd er s t at u t o ry co n s i d erat i o n s in OCGA § 3 1 -6 -4 2 an d

14u n d er g en era l a nd spe c if ic r e vie w co n s i d erat i o n s i n ru l es an d reg u l at i o n s

p ro m u l g at ed b y th e DCH as set fo rt h i n G a. C o m p

. R. & Reg s

. r.

1 1 1 -2 -1

-. 0 1 an d 1 1 1-2 -2 -.0 1 t h ro u g h 1 1 1-2 -2 -.4 3

. Un der OCGA §

3 1 -6 -4 2 (a), “ [t ] h e [DCH] s h al l i s s u e a cert i fi cat e o f n eed t o each

ap p l ican t wh o s e ap pl i cat i o n i s c o ns i s t en t wi th t he [co n s id erat i o n s s et

fo rt h i n t h e st at ut e] an d s u ch ru les dee m e d ap p l i cab l e t o a pro ject ,”

i n cl u d i n g t h e es tab l i s h m en t o f a n eed fo r t h e s erv ices

.

(Fo o tn o te o m i t t ed .) AS

MC , 3 4 4 Ga. Ap p . at 5 7 7

. An d as we h av e n o t ed

,

t h e ad m i n i s trat io n o f t h e CON p ro g ram req ui res a p art icu l arl y h i g h l ev el

o f e x p e rt i se an d s p eci al izat i o n. T h e DCH ru l es pro m u l gat ed t o

ad m i n i s ter t h e p ro g ram are d et ai l ed an d l en g th y

. See, e.g

., Ga. Co m p

. R.

& Reg s. r. 1 1 1 -2 -2 -.0 7

, wh i ch d es cri bes t h e rev i ew p ro ced u res fo r CON

ap p l icat i o ns

. Bo th t he h o s p i t a l s eek i n g a CON an d th e h o s p i t a l s

o p p o s i ng i t g a th er a n d o r

g a n i z e va s t amo u n t

s o f d a t a

, exp er t t es t i mo n

y,

a n d ot h er evi d

en ce wh i ch a r e p r es en t ed t o t h e a g en cy s t a f f, wh ich t h en

i n t er p r et s an d s yn t h es i zes t h e evi d

en ce a n d a

p p l i es i t t o th e a g en cy

r u l es

. See OCGA § 3 1 -6 -4 3

. . . .

Fu rt her ad m in is t rat i v e rev i ew i s al s o h i g h l y s peci a l i zed

. Th e h eari n g

o ffi cer w ho rev i ews t h e i n i t i al D CH s taff d e c i s i o n i s o n e o f fi ve

m em b ers o f t he CON Pan el

, al l o f w h o m are ap p o i n t ed b y t h e Go v ern o r

an d are at t orn ey s “ wh o are fam i l i ar wi th t h e h eal t h care i n du s t ry b u t

wh o do no t h av e a fi n a n ci al in t eres t i n or rep res en t o r h av e an y

co m p en s at i o n arran g em en t wi th an y h eal t h care faci l i t y

. ” OCGA §

3 1 -6 -4 4 (a), (b ).

15(Ci t at i o n an d p u nct u at io n o m i t ted ; em p h as i s s u p p l i ed

. ) Co b b Ho s p

. , 3 4 9 Ga. Ap p

. at

4 6 0 -4 6 1 (1 ) (c) (i i ). Th erefo re, t o en fo rce Geo rg i a’ s s t at ed p o l i cy d i rect iv es

, t h e CON

p ro ces s req u i res t h e DCH t o t h oro u gh l y ev al u at e a part y ’ s CON ap p l icat i o n t o en s u re

t h at “ [h ] eal t h care s erv i ces an d faci l i t i es [are] p ro v i d ed i n a m an n er t h at av o i d s

u n n eces sary d u p l i cat io n o f s erv i ces

, t hat is co s t effect i v e, t h at p ro v i d es qu al i t y h eal th

care s erv i ces

, an d t hat i s co m p at i b l e w i t h t h e h eal t h care n eed s o f t h e v ari o u s areas

an d p o p u l at i o n s o f t h e s t at e.” OCGA § 3 1 -6 -1

.

At a b are m i n im

u m

, t h en

, rev i ew u nd er t h e CON p ro c e ss fi rs t req u i res an

ap p li cat io n

. See OCGA § 3 1 -6 -4 3 (b ). Here, t h e p art ies h av e n ot i n cl ud ed a r e co rd

ci t at i o n t o, an d o u r rev i ew o f t he reco rd h as n o t rev eal ed

, an y s u ch ap p l i cat i o n fi l ed

b y W i n d y Hi l l fo r i ts ev al uat i o n

, as ei t h er a s ho rt -s t ay g en eral acu t e care h o s p i t al o r

a l on g -t erm care h o s pi t al

, at an y p o i nt i n i t s h i st o ry 6 p ri o r t o t h e 2 0 1 9 ap p l icat i o n at

i s su e i n t h i s cas e

. 7 A n d e v e n were w e t o gen ero u s l y co ns t ru e W el l St ar’ s J u n e 1 1,

6 As a res u l t , W el l St ar’ s arg u m en t t h at i t av ai l ed i t s el f of t h e CON p ro ces s in

1 9 9 6 i s u n p ers u as i v e. W e fu rt h er d i s cu s s W i n d y H i l l’ s “ g ran d fat h eri n g” in Di v i s i o n

4 i n fra.

7 In d eed

, th e reco rd d

o e s i n cl u de at l eas t t wo p ri o r cert i fi cat e o f n eed

ev al u at i on s fo r W i n d y Hi l l

— o n e fo r a ch an g e i n o w n ers h i p o f W i n dy Hi l l i n 1 9 9 3

a n d o n e fo r t h e ren o v at i o n o f t h e t hi rd fl o or o f i t s faci l i t y t o “ t o s et -u p an d s t a f f

t h i rt een (1 3 ) ad d i t i o n al l o n g -t erm acu t e care . . . b ed s . . . .”

161 9 9 6 l et t e r t o SHPA i n wh i ch i t s ou g h t t o o p erat e W i n d y Hi l l as a l on g -t erm care

h o s p it al as an “ ap p l icat i o n ,” th ere i s n o en s u in g rev i ew i n w h i ch “ [b ] o t h t h e h o s p i t al

s eek i n g a CON an d t h e h o s p i t al s o p p o s i n g i t g at h er an d org an i ze v as t am o u n t s o f

d at a, ex pert t es t i m o n y

, a n d o th er ev i d en ce wh i ch are p res en t ed to t h e ag en cy s t aff,

wh i ch t h en i n t erp ret s an d sy n th es i zes t h e ev i d en ce an d ap p l i es i t t o t h e ag en cy ru l es .”

Co b b Ho s p ., 3 49 Ga. Ap p

. at 4 6 1 (1 ) (c) (i i ). To t h e co n t rary , SHPA s t at ed i n 1 9 9 6

t h at W i n d y Hi l l n eed no t p art i ci p at e i n th e CON pro ces s a t t h a t t i m e. Th is cu rs o ry

s t at em en t hard l y p as s es as t h e eq u i v al en t o f t h e “ d et ai l ed an d l en g t h y ” rev i ew we

h av e o u t l i n ed ab o v e, w h ich wo u l d s at i s fy t h e p lai n lan g u ag e r e q u i r e m en t t h at a

h o s p it al b e “ ap p ro v ed t h ro u g h t h e cert ifi cat e o f n eed p ro ces s . . . .”

M o reo v er, we defer t o an ag en cy ’ s i n t e r p r et at i o n o f i ts ru l es an d reg u l at i on s

s o l o n g a s t h at i n t erp ret at io n i s co n s i s t en t wi th t h e CON s t at u t e. See Med ica l Cen t er

o f Cen t r al Ga

. v. Ho s

p. Au t h

. o f Mo n r o e Co u n t

y

, 3 4 0 G a. Ap p

. 4 99

, 5 0 4 (3 ) (7 9 8

SE2 d 4 2 ) (2 0 1 7 ) (“ W hi l e rev iewi n g co u r t s d efer t o ag en cy i n t erp ret at i o n s o f t h e

s t at u tes t h ey are ch arg ed wi t h ad m i n i s t eri n g

, th at d eferen ce ap p li es on l y as far as t h e

ag en cy i n t erp ret at io n i s co n s i s t en t wi t h t h e s t at u t e.”) (ci t at i on o m i t t ed ). In t h i s cas e,

fo r t h e reas o n s o u tl i n ed ab o ve, we co n cl u d e th at th e DCH’ s “ i n t erp ret at i on co rrect l y

refl ect s t he p l ai n lan g u ag e o f t h e s t at u t e an d co m p o rt s wi t h t h e l eg i s l at i ve i n ten t .” Id

.

17(B) Ef f ect o f La ck o f Cer t i f i ca t e o f N e e d P ro ces s

. Becau se we co ncl u d e t h at

W i nd y Hi l l h a s n ot b een “ ap p ro v ed t h ro u g h t h e cert i fi cat e o f n eed p ro ces s ,” i t

n eces s ari l y fo l l o ws t hat W i n d y Hi l l i s n o t en t i t l ed t o t h e b en efi t s o f t h e “ rev ers i o n

ex cep t i o n ” i n ei t h er Ga. Co m p

. R. & Reg s . r. 1 1 1 -2 -2 -.2 0 (1 ) (d ) o r 1 1 1 -2 -2 -.3 6 (2 )

(d ). As a r e s u l t

, w e co n cl ud e t h at t h e reco rd s u p p o rt s t h e DCH co m m i s s i o n er’ s

d eci s i o n t h at W i n d y

Hi l l ’ s pro po s ed co n v ers i o n fro m a l o n g -t erm care h o sp i t al t o a

s h o rt -s t ay g en eral acu t e care h o s p i t al “ wo u l d req u i re p ri o r CON rev i ew a n d

ap p ro v al .” Th erefo re, in t he ab s en ce o f an y bas i s co d i fi ed i n OCGA § 31 -6 -4 4 .1 (a),

we fu rt h er co n cl u d e t h a t t h e s u p eri o r co u rt erred i n rev ers i n g th e DCH

c o m m i s s io n er’ s d eci s i o n an d i n fi n d i n g th at “ W i n d y H i l l i s en t i t led to au t o m a t i c

rev ers i on o f it s b ed s t o s h o rt -s t ay s t at u s u n der [Ga. Co m p. R. & Reg s. r.] 1 1 1 -2 -2 -.3 6

(2 ) (d ).”

3

. Nex t

, Em o ry arg u es th at t h e s u p eri o r co u rt erred i n fi n di n g t h at a lo n g -t erm

care h o s p i t al an d a s h ort -s t ay gen eral acu t e care h o s p i t al are l eg al l y t h e s am e “ cl i n i cal

h eal t h s erv i ce,” s ee OCGA § 3 1 -6 -2 (8 ), an d t h at a n ew CON i s n o t req u ired t o s wi t ch

fro m o n e cat eg o ry o f h o s p it al t o t h e o t h er. In effect

, t h e s u p eri o r co u rt fo u n d t h at

W i nd y H i l l was au th ori zed t o o p erat e ei t her a s h o rt -s t ay g en eral acu t e care h o s p i t al

o r a l o n g -t erm

care h o s p i t al u n d er i t s 1 9 9 6 au t h o ri zat i o n . Th i s was erro r.

18In it s i n i t i al d et erm i n at io n

, t h e DCH ci t ed OCGA § 3 1 -6 -4 0 (a) (5 ) an d (6 ) an d

fo u n d t hat W i n d y Hi l l had n o t “ o ffered i n pat i en t s h o rt -s t ay acu t e care serv i ces s i nce

i t co n v e r t e d t o a [ l o n g -t erm care h o s p i t al ]

. . . 2 3 y ears ag o ” an d t h at

, as a res u l t

,

“ W i n dy Hi l l ’ s o fferi ng o f s h o rt

- s t a y acu t e care s erv i ces w h ere no n e were o ffered

wi t h i n t he p as t

. . . 1 2 m o n t h s c o n s t i t u t e s a rev i ewab l e n ew in s t i t u t i o n al h eal th

s erv i ce.” Acco rd i n gl y

, t h e DCH co n cl u d ed t h at W i n d y Hi ll ’ s pro p o s ed rev ers i o n o f

i t s lo n g-t erm c a re ho s p i tal b ed s t o s h o rt -s t ay b ed s u n d er G a. Co m p. R. & Reg s

. r.

1 1 1 -2 -2 -.2 0 (1 ) (d ) an d 1 11 -2 -2 -.3 6 (2 ) (d ) c o n s t i tu t ed “ t he d ev el op m en t of a n ew

s h o rt -s t ay h o s p i t al wh ere o ne cu rren t l y d o es n o t ex i s t [an d ] wo u l d co n s t i t u t e a

rev i ewab l e n ew sh o rt -s t ay h os p i tal an d wo u ld req u i re p ri o r CO N rev i ew an d

ap p ro v al .” On ap p eal

, t h e h eari n g o ffi cer ag reed

, no t i n g th at i t was “ un d i s p u t ed t h at

W i nd y Hi l l h as n o t offered i n p at i en t s h ort -s t ay acu t e care s erv i ces si n ce i t co n v ert ed

t o a [l o n g -t erm care h o sp i tal ]

. . . 2 3 y ears ag o ” an d th at “ [o ] perat i n g a s h o rt -s t ay

acu t e care faci li t y o fferi n g s u ch s erv i ces wh ere n o ne were o ffered o n a reg ul ar b as i s

wi t h i n t h e p rev io u s 1 2 m o nt h s wo u ld m ak e i t a ‘ n ew in s t i t u ti o n al h eal t h s erv i ce’ ” t h at

req u i red CON rev i ew an d ap p ro v al

. Th e DCH co m m i s s io ner l ik ewi s e ag reed

.

Th e s u p eri or co u rt n o t ed t h at OCGA § 3 1 -6 -2 (8 ) d efi n es “ cl in i cal h eal th

s erv i ces ” as i n cl u d i n g “ m ed i c a l

- s u r g i cal care,” b u t t hat i t d o es n ot o t h erwi s e

19d i s t i n gu i sh b et ween s h o rt -s t ay an d l o n g -t erm care. Th e s u p eri o r co u rt reas on ed t h at

,

r e g a r d l es s o f w h et h er t h e b ed s were s h ort -s t ay or l o n g -t erm

, W el l St ar o ffered s u c h

m ed i cal -s u rg i cal care b o t h b efo re an d s i n ce t h e 1 99 6 l et ter. Th e s u p eri o r co u rt t hu s

co n cl u d ed t h at W el l St ar was n o t creat i n g a “ new i n s t i t u t io n al heal t h serv i ce” t h at

req u i red CON ap pro val

.

OCGA § 3 1 -6 -4 0 (a) es t ab l i s h es wh en a n ew i n s t i t u t io n al h eal t h s erv i ce

req u i res a CON an d p ro v i d es , i n rel ev an t p art :

(a) On an d aft er Ju l y 1

, 20 0 8

, an y n ew i n s t i t u t i o n al h eal t h s erv i ce sh al l

b e req u i red t o o b t ai n a cert ifi cat e of n eed p u rs u an t t o t h i s ch ap t er. N ew

i n s t i t u t i o n al heal th s erv ices i n cl u d e:

. . .

(5 ) Cl i n i cal h eal t h s erv i ces wh i ch are o ffered i n o r t h ro u g h a h eal th care

faci l it y

, wh i ch were n ot o ffered o n a reg u l ar b as i s i n o r t h ro u gh s u ch

h e a l t h care faci l i t y wi t h i n t h e 12 m o n t h p eri o d p ri o r t o t h e t i m e s u ch

s erv ices wo u l d b e o ffered ; [an d ]

(6 ) An y co n v ers i o n o r u p g rad i n g o f an y g en eral acu te care h os p it al t o a

s p eci al t y h o s p i t al o r of a faci l i t y s uch t h at i t is co n v ert ed fro m a t y p e o f

faci l it y no t co v ered b y th i s ch ap t er t o an y o f th e t y p es o f heal t h care

faci l it i es wh i ch are co vered b y t hi s ch ap ter[.]

20See al s o Pr emi er H ea l t h Ca r e In ves t men ts v. UHS o f An ch o r

, 3 1 0 Ga. 32

, 3 5 -3 6 (2 )

(a) (8 49 SE2 d 4 41 ) (2 0 2 0 ).

Th e s u p eri o r co u rt ’ s co n c lusion ignor es ad d i t i o nal s t at u t o ry l an g u ag e an d ru l es

t h at refl ect a cl ear i n t en t t o treat s h o rt -s t ay an d lo n g-t erm b ed s d i fferen t l y

. Fi rs t

,

OCGA § 3 1 -6 -2 1 (b ) (8 ) req u ires t h e DCH t o

es t ab l i sh

, b y ru l e, n eed m et h o d o l o g i e s fo r n ew i n s t i t ut i o n al h eal t h

s erv ices an d heal t h care faci l i t i es

. . . . Th e [DCH] s hal l es t ab l i s h

s erv i ce-s p eci fi c need m et h o d o l o g i es an d cri t eri a fo r a t l ea st t h e

fo l l o wi ng cl i n ical h eal t h s erv i ces : s h o rt s t ay h o s p i t al b ed s [.] ”

(Em p h as i s s u pp l i ed .) T o t h a t en d

, t h e DCH p ro m u l g at ed “ Sp eci fi c Rev i ew

Co n s i d erat i o n s fo r Sh o rt -St ay Gen eral H o s p it al Bed s” (s ee Ga. Co m p

. R. & Reg s

. r.

1 1 1 -2 -2 -.2 0 ) an d “ Sp eci fi c Rev i ew Co n si derat io n s f o r Lo n g Term Care Ho s p i t al s ”

(s ee Ga. Co m

p

. R. & Reg s

. r. 1 1 1 -2 -2 -.3 6 ). Acco rd in g ly

, t h e CON p ro ces s ev al u at es

each cat eg o ry

o f h o s p i t al d i fferen t l y

.

Seco n d

, t he t wo t y

p es o f h o s p i t al s are defi n ed d i fferen tl y b a s ed u p o n t h e

s erv i ces t h ey p ro v i d e. A “ ‘ [s ] h o rt s t ay h os p i t al ’ o r ‘ ho s pi t al ’ i s d efi n ed as a faci l i t y

wi t h an av erag e l en g th o f s t ay o f l es s t h an t h i rt y

(3 0 ) d ay s .” Ga. Co m

p

. R. & Reg s

.

r. 1 1 1 -2 -2 -.2 0 (2 ) (n ).

21“ Lo n g T erm Care H o sp i t al ” o r “ LTCH” o r “ L on g Term A c u t e Care

Ho s p i t al ” o r “ LTACH” m ean s a h o s p i tal t hat i s cl as si fi ed as a lo n g t erm

h o s p i t al b y t h e M ed i care p ro g ram pu rs u an t t o 4 2 CFR 4 12 .2 3 (e). Th es e

h o s p i t a l s t yp i ca l l y p r ovi d e ext en d ed med i ca l a n d r eh a b il i t a ti ve ca r e f o r

p a t i en t s wh o a re cl i n i ca ll

y co mp l ex a n d m a

y s u f f er f r o m mu l t i p l e a cu t e

o r ch r o n i c co n d i t i o n s. S er vi c es t yp i ca l l y i ncl u d e co m p r eh en s i ve

r eh a b i li t a t i o n

, r es

p i ra t or y t h er a p y, h ea d t r au ma t r ea t m e n t

, a n d p a i n

ma n ag emen t

.

(Em p h as i s s u p p l ied .) Ga. Co m p

. R. & Reg s

. r. 1 1 1-2 -2 -.3 6 (2 ) ( d )

. M o reo v er,

acco rd i n g t o fed eral reg u l at i on s

, t o b e s o cl as s i fi ed

, l o n g -t erm care h o s p i t al s “ m

u s t

h a v e a n a v e rag e M ed icare i n p at i en t l en g t h o f s tay o f g reat er th an 2 5 d ay s (wh i ch

i n cl u d es al l co v ered an d n o nco v ered d ay s o f s t ay o f M ed i care p at i en ts )[.] ” 4 2 CFR

4 1 2 .2 3 (e) (2 ) (i ).

Th i rd

, t h i s d is t i n ct i o n i s rep res en t ed in t h e ev i d en ce pro v i d e d t o t he h eari n g

o ffi cer d u ri n g W el l St ar’ s ap peal fro m t h e D CH’ s i ni t i al d et erm i n at i o n

. Bet ween 1 9 7 3

an d 1 9 9 6

, i t i s un d i s p u t ed th at W i n d y Hi l l op erat ed as a s h o rt -t erm g en eral acu t e care

h o s p it al

. W h en i t co n t act ed SHPA i n 19 9 6

, W i n d y H i l l s peci fi cal l y st at ed t h at i t

wan ted t o o p erat e “ a l o n g-t erm acu te care h os p it al p u rs u an t t o 4 2 CFR 4 1 2

. 2 3 (e) (1 )

an d (2 ).” W i n d y Hi l l al s o i n d i cat ed i t wo u l d “ co n vert i t s em erg en cy ro o m d ep art m en t

t o a m i n or em erg en cy faci l i t y (“ Im m ed i at e Care Dep art m en t”).” Aft er th e SHPA

22n o t i fi ed W i n d y Hi ll t h at it wo u l d n o t n eed CON ap pro v al i n o rd er t o co n v ert t h e

h o s p it al t o a l on g -t erm care h o s p it al

, W i n d y Hi l l recei v ed a p erm i t t o o p erat e a

“ Sp eci al i zed Lo n g Term Ac u t e C a r e Ho s p i tal .” Th ereaft er, W i n d y Hi l l op erat ed as

a l o n g -t erm care h o s p i t al fo r t h e n ex t 23 y ears

. In i ts An n u al Ho s pi t al Qu es t i o n n ai re

s en t t o D C H each y ear fro m 2 0 1 5 t o 20 1 8 i n cl u s i ve, W in d y Hi ll n o t ed t h at i t

m ai n t ai n ed a p erm i t t o o p erat e a “ Sp eci al i zed Lo n g-Term A cu t e Care H o s p i t al ” an d

t h at i t h ad n o em erg en cy ro o m or an y b ed s o t h er t h an l o ng -t erm care h o s p i t al b ed s

—

i n cl u d i n g n o s h ort -s t ay

h o s pi t al b ed s

.

Th es e fact o rs i n di cat e a cl ear l eg al d i s t i n ct i on b et ween s ho rt -s t ay g en eral acu t e

care h os p i t al s an d lo n g -t erm care h o s p i t al s

, an d d em o ns t rat e th at W i n d y Hi l l was

b ei n g op erat ed as a lo n g -t erm care h o sp i t al

. Th at t here m a y b e a m i n i m al l ev el o f

o v erl ap b et ween t h e t wo cat eg o ri e s d oes n o t al t er th e fact t h at t h e cat eg o ri es are

d efi n ed d i fferen t l y

, ev al u at ed d i fferen t ly

, rep o rt ed d i fferen t l y

, an d p ro v i d e d i fferen t

l ev el s of care. 8 Acco rd in g t o W i n d y Hi l l ’ s o wn ev i d en ce, i t m ai n t ai n ed 4 7 lo n g -t erm

8 M o reo v er, d es p i t e an y

o v erl ap i n t he m an n er o f care p ro v i d ed b y s h o rt -s t ay

g en eral a c u t e care ho s pi t al s an d l o n g -t erm care h o sp i t al s

, t he reg u l at io n s l awfu l l y

p ro m u l gat ed b y t he DCH n ot e t h at a l on g -t erm care h o s p i t al g en eral l y p ro v i d es

“ ex t en d ed m ed i cal an d reh ab i l i t at i v e care fo r p at i en t s wh o are cl i n ical l y co m p l ex an d

m ay s u ffer fro m

m u l t i pl e acu t e o r ch ro ni c co n d i t i o n s [,] ” i n cl u d i n g “ co m p reh en s i v e

r e ha bilita tion, r e spir a tor

y t h erap y

, h ead t rau m a t reat m en t

, an d p ai n m an ag em en t

. ” G a

. Co m p

. R. & Reg s

. r. 1 11 -2 -2 -.3 6 (2 ) (d ). T h ere are n o su ch l i m i t at i o n s o n t h e ro l e o f

23care h o sp i t al b ed s

, an d o n l y l o n g -t erm care b ed s

, w h en i t s ou g h t t o co nv ert i t s en t i re

co m p l em en t of 11 5 b ed s t o sh o rt -s t ay b ed s i n 20 1 9

, aft er h av i n g o perat ed as a l o n g

t erm care h o s p i t al fo r m o re t h an 2 0 y ears

. As a res u l t

, W i n d y Hi ll ’ s an n u al rep o rt i n g

co n fi rm ed t h at i t d i d no t m a in t ai n an y bed s fo r p ed i at ri c care, g y n eco l og i cal care,

g en eral m ed i ci n e, g e n e r a l s u rg ery

, o r m ed i cal / s u rg i cal care. 9 U nd er th es e fact s

, t h e

DCH co m

m i s s i o n er was au t h o ri zed t o fi nd th at W i nd y H i l l ’s p r o p o s ed co n v ers i o n

co n st i t u t ed a “ new i n s t i t u ti o n al h eal t h s erv i ce” t h at req u i red p ri o r CON rev i ew an d

ap p ro v al

. See OCGA § 3 1 -6 -4 0 (a) (5 ) (s t at i n g t h at a n ew in s t i t u ti on al h eal th s erv i ce

i n cl u d es “ [c] l i n ical h eal t h s e rv i ces wh i ch are o ffered i n o r t h ro u g h a h eal t h care

faci li t y

, wh i ch were n o t o ffered o n a reg u l ar b as i s i n o r t h r o u g h s u ch h eal t h care

faci li t y wi t h i n t h e 1 2 m o n t h p eri o d p ri o r t o t h e t i m e s u ch s erv i ces wo u l d b e

o ffered ”). 1 0 Becau s e t h e s u p eri o r co u rt i m p erm i s s i bl y eq u at ed t h e t wo cat eg o ri es t o

a s h o rt -s t ay

g en eral acu t e care h o s p i t al

.

9 Fo r t h i s reas o n

, co u p l e d wi t h W el l St ar’ s 1 9 9 6 s u rren d er of i t s “ Gen eral

Ho s pi t al ” p erm i t

, W el l St ar’ s arg u m en t s

— t h at sh o rt -s t ay care an d l o n g-t erm care are

es s en t i al l y t he s am e a n d e n c o m p as sed u n d er a b ro ad “ cl i n i cal h eal th s erv i ce” o r

“ m ed i cal -s u rg i cal care” u m b rel l a — are u n av ai li ng

.

1 0 Fu rt h erm o re, we fi n d u n p ers u as i v e W el l St ar’ s arg um en t

, b as ed u p o n OCGA

§ 3 1-6 -4 0 (a) (6 ), t h at i t i s en t i t led t o fo reg o t h e CON p ro ces s b ecau se a CON wo u ld

o n l y b e req u i red fo r “ t h e co nv ers i o n o r up g rad i n g o f an y g en eral acu t e care h o s p i t al

t o a s p eci al t y h o sp i tal bu t n o t t he co n v ers e” i n v i ew o f t h e ap p l icat i o n o f OCGA § 3 1

-

24h o l d t h at W in dy Hi l l d i d n o t n eed p ri o r CON ap p ro v al

, an d fi nd i n g n o b as is to

rev ers e t h e DCH co m

m i ss i o n er’ s d eci s i o n u n d er O CGA § 3 1-6 -4 4

. 1

, we ag ai n

co n cl u d e t h at t h e s u p eri or co u rt erred i n rev ers i n g t h e fi n al ag en cy d eci s i o n.

4

. Fi n al l y

, i n two in terrel at ed en u m erat i o n s o f erro r, Em o ry as s ert s t h at t h e

s u p eri o r co u rt erred i n fi n d in g t h at W el l St ar had a “ v es t ed ri g ht ” t o “ p ro vi d e [l o n g

t erm care h o s p i t al ] s erv i ces wh il e ret ai n i n g i t s s t at u s as a g en eral acu te care h o s p i t al ”

an d t h at rev ers i n g t h e DCH co m m i s s i o ner’ s d eci s i on “ av o i d s an u n co n s t i t u t i o n al

res u l t,” wh i ch

, Em ory arg u es , i t s el f res u l t s i n an u n co n s t it u ti o n al ap p l i cat i o n o f t h e

ru l es an d s t at u t es go v ern i n g t h e CON p ro gram

. 1 1 W e co n cl u d e th at W el l St ar d i d n ot

6 -4 0 (a) (5 ).

1 1 Th e Su p rem e Co u rt o f Geo rg ia “ has ex cl u si ve ju ri s d i c t i o n o v er al l cas es

i n v o l v i n g co n s t ru ct i o n of t h e Co n s t i t u t i o n o f t h e St at e o f Geo rg i a an d o f t he Un i t ed

St at es an d al l cas es i n w h ich t he co n s t i t u t i on al i t y o f a l aw, o rd i nan ce, o r

co n st i t u t io n al pro vi s io n h as b een cal l ed in t o q u es t i o n

. ” At la n t a In d ep en d en t S ch o ol

S ys t em v

. La n e

, 26 6 Ga. 6 5 7 (1 ) (4 6 9 SE2 d 2 2) (1 9 9 6 ); acco rd G a. Co n s t

. o f 1 9 8 3,

Art . VI, Sec. VI, Par. II (1 ). Ho wev er, t h i s Co u rt h as “ l i m i t ed ju ri s d i ct i o n t o rev i ew

co n st i t u t io n al q u es t i o ns .” Ci t y o f Deca tu r v. DeKa l b Co u n t y

, 2 8 4 Ga. 4 34

, 4 3 6 (2 )

(6 6 8 SE2 d 2 4 7 ) (2 0 0 8 ). As a res u l t

, we h av e ju ri s d i ct i o n o v er cas es t h at “ i n v o l v e t h e

ap p li cat io n

, i n a g en eral s en s e, o f u n q u es ti o n ed an d u n am b ig u o u s p ro v i s io n s o f t h e

Co n s t i t u ti o n t o a g i v en s t at e o f fact s an d t h at do n o t i n v ol v e co ns t ru ct i o n o f s o m e

co n st i t u t io n al pro vi s io n di rect l y i n q u es t i o n an d d o u b t fu l ei t her u n d er i t s o wn t erm s

o r u nd er t h e d eci s i o n s o f t h e Su p rem e Co u rt o f Geo rg i a o r t h e Su p rem e Co u rt o f t h e

Un i ted St at es .” Id

. (p u n ct u at i o n o m i t t ed ). He r e

, i t i s n o t cl ear t h at a co n s t i t u t i o n al

q u es ti o n was s q u arel y rai s ed bel o w

. F u rt h erm ore, t h e res o l ut i on o f t h e q u es t i o n

ap p ears t o i n vo l v e t h e a p p l i cat i o n o f s et t l ed co ns t i t u ti o n al law. Un d er t h es e

25h av e a v es t ed r i g h t t o rem ai n a g en eral acu t e care h o s p i tal t h ro ug h o u t i t s op erat i o n

as a l o n g -t erm

care h o s p i t al

.

In i t s o rd er, t h e s u p eri o r co u rt t aci t l y fo u n d th at W i n dy Hi ll h ad a v es t ed ri g ht

t o o p erat e as a s h o rt -s t ay g en eral acu t e care h o s p it al bas ed u po n t h e 1 9 9 6 l et t er fro m

SHPA. 1 2 As a res u l t , t h e s u peri o r co u rt co ncl u d ed t h at

[ e ]v en i f “ s h o rt -s t ay bed s ” an d “ l o ng -t erm b ed s ” were d i s t i nct cl i n ic a l

h eal th s erv i ces

, [t h e] DCH c an n o t i n t erp ret i t s l at er-ad o p ted ru l es t o

ret ro act iv el y t ak e away W i n d y Hi l l ’ s v es t ed ri g h t t o p ro v i d e b o t h

s h o rt -s t ay an d lo n g -t erm m ed i cal -s urg i cal care. A s refl ect ed b y t h e 1 9 9 6

[SHPA l et t er]

, W i n dy Hi l l h ad a ri g h t t o p ro vi d e [l o n g -t erm care

h o s p i t al ] s erv i ces wh il e ret ai n i n g i t s s t at u s as a g en eral acu t e care

h o s p i t al

. Th a t ri g h t

— ex p res s l y reco g n i zed i n a ru l i n g fro m t h e s t at e

CON ag en cy

— h as n ev er b een rel i n q u i s h ed

. Th u s

, ev en i f [t h e] DCH’ s

s u b s eq u en t ad o p t io n of s ep arat e ru l es fo r Sh o rt -St ay Ho sp i t al Bed s an d

Lo n g Term Care Ho s p i t al s creat ed di s t i n ct cl i n i cal h eal t h s e r v i ces

,

W i n d y H i l l h ad al read y v e s t e d i ts ri g h t t o o ffer l o n g -t erm b ed s w h i l e

ci rcu m s t an ces

, ju ri s d ict i o n i s p ro p er i n t h i s Co u rt

.

1 2 Th e s u p eri or co u rt ’ s o rd er d oes n o t m ak e an ex pres s fi n d in g th at W i n d y Hi l l

h as a v es t ed ri gh t

. Ev en t o t h e ex t en t i t m ad e s u ch a fi n d i n g

, t h e o rd er co n t ai n s n o

an al y s i s ex p lai n i n g h o w t h e s u p eri o r co u rt d et erm i n ed t hat W i n dy Hi l l ’ s p r i o r

o p erat i o n as a s h o rt -s t ay g en eral acu t e care h os p it al qu al i fi ed as a v es t ed r i g h t

. Rat h er, i t s i m

p l y refers t o th e Geo rg i a Co n s t i t u t i on ’ s p r o h i b i t i o n ag ai ns t ap p l y i n g

l aws “ ret ro act i v el y

s o as t o i m

p ai r v es t ed ri g h t s .”

26ret ai ni ng it s g en era l acu t e care CON au t ho ri zat i o n

, in cl u d i n g o fferi n g

m ed i cal -s u rg i cal care.

Ou r Su p rem e Co u rt “ has s ai d t h at t h e t erm v es t ed ri g h ts m ean s i n t eres t s wh i ch

i t i s p ro p er fo r t he s t at e t o reco g n i ze an d p ro t ect an d o f wh i ch t h e i n d iv i d ual can n ot

b e dep ri v ed arb i t rari l y wi t h o u t i n ju st i ce.” (Ci t at i o n an d pu n ct uat i o n o m i t t ed .) Dea l

v. Co l ema n

, 2 94 Ga. 1 7 0

, 1 7 7 (2 ) (a) (7 5 1 S E 2 d 3 37 ) (2 0 13 ). Ho wev er, “ ‘ v es t ed

ri g h t s ’ m u s t b e pr i va t e ri gh t s

, an d p ub l ic ri g h t s

— th os e ri g ht s t h at b el o n g t o t h e

Peo pl e i n co m

m o n

— can b e m o d i fi ed b y t h e el ect ed rep res en t at i v es o f th e Peo p l e

p ro s p ect i v el y o r ret ro act i vel y

, as t hey see fi t

. ” (Em ph as i s s up p l i ed .) Id

. at 1 8 1 (2 ) (a).

Fu rt h erm o re, li k e t h e Op en Reco rd s Act at i s s ue i n Dea l

, th e CON l a w s were

“ en act ed fo r t h e p ro t ect io n o f t h e p u b l i c, an d n o t f o r t h e b en efi t o f an y p art i cu l ar

i n d i v i d u al o r cal l i n g

. ” (Ci t at i o n an d p u n ct u at i o n o m i t t ed .) See i d. at 18 0 (2 ) (a); s ee

al s o OC GA § 3 1-6 -1 (s tat i n g t h at p ub l i c p o l i cy su p p o rt i n g CON laws i s “ t o en s u re

a cces s t o q u al it y h eal t h care serv i ces an d t o en s u re t hat h eal t h care serv i c e s a n d

faci li t i es are d ev el o p ed in an ord erl y an d eco no m i cal m an ner an d are m ad e av ai l ab l e

t o a l l ci t i z en s an d t h at on l y t h o s e h eal t h care s e r v i c e s fo u n d t o b e i n th e p u b l i c

i n t e r es t s h al l be p ro v i d ed i n t h i s s t at e”) (em p h as i s s u p p l i ed ); Co b b Ho s p

. , 3 4 9 Ga.

27Ap p

. at 4 5 6 (1 ) (a) (fi n di n g t h at “ t h e p u b li c i s b et t er s erv ed by h av i n g ex pert s i n t h e

co m p l ex i t i es o f h eal th care p l an n i ng m ak e . . . d eci s i o ns ”).

Here, th e su p eri or co u rt co n cl u d ed

, i n effect

, t h at W i nd y H i l l i s free t o o p erat e

ei t h er l o n g -t erm b ed s o r s ho rt -s t ay b ed s b ecau se W i n d y Hi l l was g ran d fat h ered i n to

t h e CON p ro g r a m

. Th i s was erro r. It i s tru e th at

, wh en t h e CON reg u l at i o n was

en act ed , i t d id n o t ap p l y t o th o s e faci l i t ies th at p re-ex i s t ed t h e l eg is lat i o n . See HCA

Hea lt h S vcs

. v. Ro a ch

, 2 6 3 G a. 7 9 8

, 8 0 0 (3 ) (a) (4 3 9 SE2 d 49 4 ) (1 9 9 4 ), o v erru l ed o n

o t h er g ro u n d s b y Ma r

s h v. Cl ar ke Co u n t

y S ch o o l D i s t r i ct

, 2 9 2 G a. 2 8 (7 3 2 SE2 d 4 4 3 )

(2 0 1 2). Su ch “ g ran dfat h eri ng ” ap p l i es to faci l i t i es t h at “ ex i s t ed an d p er f o r med t h e

s a me s er vi ces pri or t o t he CON p ro gram in 1 9 7 9 .” (Em p h as i s s u pp l i ed .) Id

. at 8 0 1 (3 )

(a). In o t h er w o rd s

, faci l i t i es were al l o wed t o co n t i n u e o perat in g i n t he s am e m an n er

as t h ey h ad o p erat ed p ri o r to t h e en act m en t o f t he CON l aws

. See al s o O CGA § 3 1 -6

-

4 0 (c) (1 ) (“ An y pers o n wh o h ad a v al i d ex em p t i o n g ran t ed o r ap p ro v ed b y t h e fo rm er

Heal t h Pl an n i n g Ag en cy o r t h e d ep art m en t pri o r to J u l y 1

, 2 0 0 8

, s hal l n o t b e req u i red

t o o b t ai n a cert i fi cat e o f n e e d i n o rd er t o co n t in u e t o o ffer t h o s e p rev i o u s l y o ffered

s erv i ces

. ”).

28Pri o r t o 1 9 7 9

, W i n d y Hi l l o p erat ed as a s ho rt -t erm g en eral acu te care h o s p i t al

. 1 3

Th erefo re, d u e t o th e ab il i t y t o b e “ g ran d fat h ered ” i n

, W i n d y H i ll c o n ti n u ed to

o p e rat e as a s h ort -s tay g en eral acu t e care h o sp i t al aft er t h e CON l aws b ecam e

effect i v e i n 19 7 9

. In 1 9 9 6

, W i n d y Hi l l t ran s fo rm ed fro m a s h o rt -s tay h o s p i t al t o a

l o n g -t erm care h o s pi t al an d t h u s n o l o n g e r pro v id ed t h e s am e serv i ces it p ro v i d ed

p ri o r t o t h e CON p ro g ram i n 1 9 7 9

. Un d er t hes e ci rcu m s t an ces

, W el l St ar rel i n q u i s h ed

an y ri gh t i t h ad o b tai ned b y o p erat i o n o f b ei n g g ran d fat h ered t o o p e r a t e as a s h o rt

s t ay ho s p i t al

. 1 4

1 3 In i t s i n i t i al det erm i n at i o n

, t he DCH no t ed t h at W i nd y H i l l “ o r i g i n al l y

o p erat ed as a s h o r t

- s t a y h o s p i t al w i t h 1 6 5 b ed s

. Th e Geo rg i a CON st at ut e b ecam e

effect i v e i n 1 9 7 9 [; ] as a res u l t W i n d y Hi l l ’ s op erat i on o f i t s s h o rt -s t ay h o s pi t al was

g ran d fat h ered u n d er th e l aw.” In d eed

, W i n d y Hi ll ack n o w l ed g ed as m u ch

, s t at i n g in

i t s CON ap p li cat i o n t h at “ [s ] i n c e i t s f o u n d i n g i n 1 9 7 3, W el l St ar W i nd y Hi l l h ad

o p erat ed as a g en eral acu t e care s h o rt -s tay h o s p i tal .”

1 4 In fact

, t o t he ex t en t t h e 1 9 9 6 l et t er co n v ey ed an y ri g h t at al l

, it g ran t ed

W i nd y Hi l l t he ri gh t t o o p e r at e as a l o n g -t erm care h o s pi t al

— ju st as W i n d y Hi l l

s o u g ht

. See G a

. C o m

p

. R. & Reg s

. r. 1 1 1-2 -2 -.1 0 (1 ) (a) (“ Det erm i nat i o n s are

co n cl u s i o n s of t h e Dep art m en t t h at are bas ed o n s p eci fi c fact s an d are li m i ted t o t h e

s p eci fi c i s s u es ad d res s ed i n t he req ues t fo r d et erm i n at i o n

, as ap pl i cab l e. Th erefo re,

t h e co n cl u s i o n s o f a s p eci fi c d ete r m inat i on s h al l hav e n o bi n di n g p reced en t i n rel at i o n

t o p art ies n o t s ub

ject t o t he req u es t an d t o o t h er fact s or fact u al s i t u at i o ns t h at are n ot

p res en t ed i n t h e req u es t .”). As we h av e n o t ed

, aft er t h e SHPA i s s ued it s 1 9 9 6 l et t er,

W i nd y Hi l l r e c ei v ed a n ew p erm i t au th o ri zi ng it t o o p erat e as a “ Sp eci al i zed Lo n g

Term Acu t e Care Ho s pi t al ,” an d ret u rn ed i t s fo rm er p erm i t

, w h i ch h ad au t h o ri zed

W i nd y Hi l l t o op erat e as a “ Gen eral Ho s pi tal ” an d wh ich t h e S H P A m ark ed as

“ Vo i d .”

29F u r t h e r m o re, as t h e DCH co m m i s s i o n er fo u n d, an d co n t rary t o W el l St ar’ s

arg u m en t

, co n cl u di n g t h a t a faci l i t y i s en t i t l ed t o s w i tch b ack an d fo rt h b et ween

o p erat i n g s h o rt -s t ay an d long- te r m be ds unde r

m in es t h e p u rp o s e o f t h e CON p ro g ram

.

As a m at t er o f ex p res s pu b l i c p o l i cy

, OCGA § 3 1-6 -1 req u i res t h e DCH t o en s u re t h at

h eal t h care s erv ices an d faci l it i es are p ro v i d ed i n a m an ner t h at i s co s t -effect i v e an d

t h at av o i d s t he u n ne c e s s a ry d u p l i cat io n o f s erv ices

. If W i n d y Hi l l

, or an y o t h er

f a ci l i t y

, ret ai ns a p u rp o rt ed ri g h t t o u n il at eral l y ch an g e t h e n at u re of t h e s erv i ces i t

o ffers

, t h e D CH wo u l d b e p recl u d ed fro m fu l fi l li n g i t s l eg is l at i v e l y- m an d at ed

reg u l at o ry ro l e, an d t h e co d i fi ed p u b li c p ol i cy u n d erl y i n g t h e CON p ro ces s wo u l d b e

ren d ered m ean in g l es s

. W e can n o t read t h e rel ev an t ru l es an d s t at u t es i n s u ch a way

.

See g en eral l y La n g l e

y v

. La n gl ey

, 2 7 9 G a. 3 74

, 3 76 (1 ) (6 1 3 SE2 d 6 1 4 ) (2 0 0 5 )

(h o l d i n g t h at

, i n cas e wh ere en fo rcem en t o f an ag reem en t was a m at ter o f p u b l i c

p o l i cy , “ co n si d erat i o n s o f p u b l i c p o l i cy can n ot b e i g n ored ”).

Fi n al l y

, h av i ng fai l ed t o d em o n s t rat e a v es t ed ri g h t t o o p erat e as a s h o rt -s t ay

g en eral acu t e care h o s p it al

, i t n eces s ari l y fo l l o ws t h at W el l St ar can n o t s h o w a

v i o l at i o n o f i t s co n s t i t u ti o n al ri g h t s. 1 5 Th e s u p eri o r co u rt erred i n h o l d i n g o t h erwi s e. 1 6

1 5 In i t s m o t i o n fo r s u m m ary ad ju d i cat i o n b efo re t h e CON Ap peal Pan el

, W el l St ar arg u ed th at Em o ry ’ s p ro p o s ed read i n g o f cert ai n CON reg ul at i o n s “ wo u ld

cau s e an u nco n st i t u t i o n al ret ro act i v e i m pai rm en t o f W el l St ar W i n d y Hi l l ’ s v es t ed

30Ca s e No . A2 2 A0 1 1 2

5

. In Cas e No , A2 2 A 0 11 2 , t h e DCH as s ert s t h at t h e s u p eri o r co u rt : (1 ) rel i ed

u p o n an u n reas o n ab l e i nt erp ret at i o n o f t h e fact s ; (2 ) m i s i n t erp ret ed th e ru l es

g o v ern i n g CONs ; (3 ) m i s i n t erp ret ed t h e t erm “ cl i n i cal h eal t h s erv i ces ”; (4 )

erro neo u s l y fo un d t hat rev ers in g t h e DCH’ s d et erm ina t io n av o id s an u n co n s t i t u t i o n al

res u l t; an d (5 ) erred i n fi n d i n g t h at t h e DCH’ s d et erm i n a t i o n was arb i t rary an d

cap ri ci ou s

.

Ho wev er, i n v i ew o f o u r d eci s i o n i n Cas e No

. A2 2 A0 1 1 1 rev ers i n g t h e

s u p eri o r co u rt ’ s o rd er g r a n t i n g W el l St ar’ s p et i t i on fo r ju d i ci al rev i ew, we n eed n ot

co n si d er t h e DCH’ s en u m era t i o n s o f erro r. A cco rd i n g l y

, Cas e N o

. A2 2 A0 1 1 2 i s

ri gh t s t o rem ai n a gen eral acu t e care h o s pi t al t h ro u g h o u t o perat io n as [a lo n g -t erm

care h o sp i t al .] ” Th erefo re, W el l St ar p ro p erl y rai s ed t h e arg u m en t d u ri ng t h e ag en cy

p ro ceed in g s

, an d t h e su p eri o r co u rt was au t h o ri zed t o co n s i d er W el l St ar’ s arg u m en t

. See Co bb Ho s

p

. v. Dep t

. o

f Co mmu n i t

y Hea l th

, 3 57 G a. A p p

. 3 5 8

, 36 0 (8 5 0 SE2 d

8 3 1 ) ( 2 0 2 0 ) (“ A p art y ag g ri ev ed b y a s t at e ag en cy ’ s d eci s i o n m u s t rai s e al l i s s u es

b efo re t h at ag en cy an d ex h au s t av ai l ab l e ad m i n i s t rat i v e rem ed i es b efo re s eek i n g an y

ju d i ci al rev i ew o f t h e ag en cy ’ s d eci s i o n

. ”) (ci t at i o n an d p u n ct u at io n o m i tt ed ).

1 6 W e need n o t co n s i d er Em o ry ’ s rem ai n in g en u m erat i o n t h at t h e su p eri o r co u rt

fai l ed t o ad d r e s s it s arg um en t t h at W el l St ar’ s p ro p o sal res u l t ed in a n ew s h o rt -s t ay

g en eral acu t e care h o s pi tal w i t ho u t o b t ai n i n g a n ew CON. See O CGA § 3 1 -6 -4 0 (a)

(1 ).

31d i s m i s s ed as m o ot

. See g en eral ly Tu r n er Ou t do o r Ad ver t i si ng v. W

er co

, 1 9 4 Ga. Ap p.

1 4 , 1 5 (2 ) (3 8 9 SE2 d 7 7 8 ) (1 9 89 ).

In s u m

, we co n cl ud e t hat t h e s u p eri o r co u rt erred i n fi n d i n g t h at : (1 ) “ W i n dy

Hi l l i s en t i t l ed t o au t o m at i c rev ers i on o f i ts b ed s t o s h o rt -s tay st at us u n d er [Ga. Co m p.

R. & Reg s

. r.] 1 11 -2 -2 -.3 6 (2 ) (d )[; ] b ecau se W i n d y Hi l l was n o t a ‘ [a] h os p i t al t h at

[h ad ] b een ap p ro v ed th ro u g h t h e Cert i fi cat e o f Need p ro ces s [; ] ’ ” (2 ) a l o n g -t erm care

h o s p it al an d a s h ort -s t ay gen eral acu t e care h o sp i t al are l eg a l l y t he s am e “ cl i n i cal

h eal t h s erv i ce,” s uch t h at a n ew CON i s no t req ui red t o s wi tch fro m o n e cat eg o ry o f

h o s p it al to t he o t h er; an d (3 ) W el l St ar had a “ ves t ed ri g h t ” t o “ p r o v i d e [ l o n g -t erm

care h o sp i t al ] serv i ces wh i l e ret ai n i n g i t s st at us as a g en eral acu t e care h os p i t al ” an d

t h at rev ers i n g the D C H c om m issione r ’ s de c ision “ a voids a n u nc on s t i t u t io n al res u l t[.] ”

Th erefo re, we rev ers e t h e s u p eri o r co u rt ’ s j u d gm en t i n Cas e No

. A2 2 A0 1 1 1 an d

d i s m i s s Cas e No . A2 2 A0 11 2 as m oo t

.

Ju d g men t r ever

s ed i n Ca s e No

. A2 2

A0 11 1

. Ap

p ea l d i s mi s s ed a s mo o t i n Ca s e

No . A2 2 A0 1 1 2 . Ba r n es , P. J., a n d Br o wn , J., co n cu r

.

32