Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-2 - HEALTH PLANNING › Subject 111-2-2 - CERTIFICATE OF NEED › Rule 111-2-2-.09 - General Review Considerations

Current through Rules and Regulations filed through June 27, 2024
(1)
General Considerations
. The
				burden of proof for producing information and evidence that an application is
				consistent with the applicable considerations and review policies, which
				follow, shall be on the applicant. In conducting review and making findings for
				Certificates of Need, the Department will consider whether:
(a) the proposed new institutional health
				services is reasonably consistent with the relevant general goals and
				objectives of the State Health Plan. The goals and objectives related to issues
				and addressed in the State Health Plan, which are relevant to the Certificate
				of Need proposal, will be considered in the review. It should be recognized
				that the goals of the State Health Plan express the ideal and, in some
				respects, may be incompatible with the concept of cost containment. The
				statutes and Rules represent the final authority for review decisions and the
				content of the Plan, or any component thereof shall not supersede the Rules in
				such determination;
(b) the
				population residing in the area served, or to be served, by the new
				institutional health service has a need for such services;
1. Population projections used by the
				Department will be resident population figures prepared or approved by the
				Office of Planning and Budget or other official figures that may be applicable
				as determined by the Department.
2.
				Updated resident population projections will be utilized upon the official
				effective date as stated by the Department, pursuant to these Rules, replacing
				and superseding the older data.
3.
				The projection period or horizon year for need determinations will be five
				years for hospital services and three years for all other services, unless
				otherwise provided by the Rules for the specified service. The projection
				period or horizon year will be advanced to the next projection year or horizon
				year on or about April 1 of each year.
4. Inpatient facilities will be inventoried
				on the basis of bed capacity approved, grandfathered, or authorized through the
				Certificate of Need process regardless of the number of beds in operation at
				any given time or which may be licensed by the Healthcare Facility Regulation
				Division.
5. Data sources to be
				utilized by the Department to evaluate need, population characteristics,
				referral patterns, seasonal variations, utilization patterns, financial
				feasibility, and future trends will include, but not be limited to, the
				following:
(i) any surveys required by the
				Department, including but not limited to those for hospitals, nursing
				facilities, home health agencies, specialized services, and ambulatory surgery
				facilities;
(ii) Cost reports
				submitted to fiscal intermediaries and the Department;
(iii) periodic special studies or surveys, as
				produced or formally adopted or used by the Department;
(iv) the United States Census and other
				studies conducted by the Census and other Federal and State agencies and
				bureaus, including but not limited to, the Department of Labor; and
(v) such other data sources utilized by the
				Department for measurement of community health status. Such data may include
				information submitted by the applicant pursuant to Ga. Comp. R. & Regs.
				111-2-2-.06(2)(f),
				which may be necessary for the Department to ensure that the project is
				consistent with applicable general consideration provisions.
6. All data used by the Department
				in a Certificate of Need review will be available to the applicant on request,
				in accordance with Department policies on requested information. The most
				recent data reported and validated will be used in the analysis of a
				proposal.
(c) existing
				alternatives for providing services in the service area the same as the new
				institutional health service proposed are neither currently available,
				implemented, similarly utilized, nor capable of providing a less costly
				alternative, or no Certificate of Need to provide such alternative services has
				been issued by the Department and is currently valid
1. The Department supports the concept of
				regionalization of those services for which a service-specific Rule
				exists.
2. The Department shall
				consider economies of scale where need exists for additional services or
				facilities.
3. Utilization of
				existing facilities and services similar to a proposal to initiate services
				shall be evaluated to assure that unnecessary duplication of services is
				avoided. Where there exists significant unused capacity, initiating a similar
				service in another health care facility would require strong justification
				under other criteria.
(d)
				the project can be financed adequately and is in the immediate and long term,
				financially feasible;
(e) the
				effects of the new institutional health service on payors for health services,
				including governmental payors, are reasonable;
(f) the costs and methods of a proposed
				construction project, including the costs and methods of energy provision and
				conservation, are reasonable and adequate for quality health care. Construction
				plans will be reviewed in detail to assure that space is designed economically.
				Space shelled-in for some future use will not be accepted unless the applicant
				demonstrates that the shelled-in space will not be directly related to the
				provision of any clinical health service;
(g) the new institutional health service
				proposed is reasonably financially and physically accessible to the residents
				of the proposed service area and will not discriminate by virtue of race, age,
				sex, handicap, color, creed or ethnic affiliation;
1. In accordance with the provision found in
				O.C.G.A. §
											31-6-42(7), the
				Department will evaluate the extent to which each applicant applying for a
				Certificate of Need participates in a reasonable share of the total community
				burden of care for those unable to pay. This provision shall not apply to
				applicants for life plan communities, skilled nursing facilities or units, and
				to projects that are reviewed by the Department on an emergency basis in
				accordance with Ga. Comp. R. & Regs. r.
				111-2-2-.07(1)(k).
				In all other instances, the following indicators will be evaluated:
(i) administrative policies and directives
				related to acceptance of indigent, medically indigent, and Medicaid
				patients;
(ii) policies relating
				medical staff privileges, if applicable, to reasonable acceptance of emergency
				referrals of Medicaid and PeachCare patients and all other patients who are
				unable to pay all or a portion of the cost of care;
(iii) evidence of specific informational
				efforts targeted toward patients regarding arrangements for satisfying
				charges;
(iv) documented records of
				refunds, if any, received from the Federal, State, county, city, philanthropic
				agencies, donations, and any other source of funds other than from direct
				operations, such as indigent care trust fund distributions and disproportionate
				share payments, if applicable;
(v)
				the applicant's commitment to participate in the Medicare/Medicaid and
				PeachCare programs; to provide legitimate emergency care, if applicable,
				regardless of ability to pay; and to provide indigent and charity care;
				and
(vi) documented records of care
				provided to patients unable to pay, Medicare and Medicaid contractual
				adjustment, Hill-Burton payments (if applicable), other indigent care, and
				other itemized deductions from revenue including bad debt. Such records shall
				demonstrate that the levels of care provided correspond to a reasonable
				proportion of those persons who are medically or financially indigent and those
				who are eligible for Medicare or Medicaid within the service
				area.
2. The evaluation
				in 1. above is in addition to satisfaction of a minimum indigent and charity
				care commitment required by prior CON(s), if any.
(h) the proposed new institutional health
				service has a positive relationship to the existing health care delivery system
				in the service area;
(i) the
				proposed new institutional health service encourages more efficient utilization
				of the health care facility proposing such service;
(j) the proposed new institutional health
				service provides, or would provide a substantial portion of its services to
				individuals not residing in its defined service area or the adjacent service
				area;
(k) the proposed new
				institutional health service conducts biomedical or behavioral research
				projects or new service development that is designed to meet a national,
				regional, or statewide need;
(l)
				the proposed new institutional health service meets the clinical needs of
				health professional training programs;
(m) the proposed new institutional health
				service fosters improvements or innovations in the financing or delivery of
				health services; promotes health care quality assurance that can be documented
				with outcomes greater than those which are generally in keeping with accepted
				clinical guidelines, peer review programs and comparable state rates for
				similar populations; promotes cost effectiveness; or fosters improvements or
				innovations in the financing or delivery of health services; or fosters
				competition that is shown to result in lower patient costs without a
				significant deterioration in the quality of care;
(n) the proposed new institutional health
				service fosters the special needs and circumstances of Health Maintenance
				Organizations;
(o) the proposed new
				institutional health service meets the Department's minimum quality standards,
				including, but not limited to, standards relating to accreditation, minimum
				volumes, quality improvements, assurance practices, and utilization review
				procedures;
(p) the proposed new
				institutional health service can obtain the necessary resources, including
				health care management personnel; and
(q) the proposed new institutional health
				service is an underrepresented health service, as determined annually by the
				Department. The Department shall, by rule, provide for an advantage to equally
				qualified applicants that agree to provide an underrepresented service in
				addition to the services for which the application was originally
				submitted.