reglab/statecodes huggingface dataset:
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-.05 - Enforcement

Current through Rules and Regulations filed through June 27, 2024
(1) Revocation
(a) In the event that the Department has
				cause to consider revocation of a Certificate, in whole or in part, the
				Department shall provide notice to the holder of the Certificate and shall hold
				a hearing to determine whether the holder has:
1. Intentionally provided false information
				to the Department;
2. Failed to
				incur a financial obligation in accordance with the Certificate as
				granted;
3. Failed to implement the
				project in accordance with the specific purpose(s) for which the certificate
				was granted or failed to meet the initial twelve (12) month performance
				standards or failed to request an extension of such standards. For certificates
				issued on or after July 1, 2008, failed to implement the services or units of
				services for which the Certificate of Need was issued, and that were outlined
				in or on the certificate granted, in a timely manner as also outlined in or on
				the certificate granted, as provided by O.C.G.A. §
											31-6-45(a.1);
4. Transferred controlling ownership in the
				facility before completion of the project without prior written approval of the
				Department, except as authorized by Ga. Comp. R. & Regs. r.
				111-2-2-.02(4);
6. Changed the defined location of the
				project except as allowed by O.C.G.A. §
											31-6-45(a)
				 authorizing change in location under certain
				conditions;
7. Failed to comply
				with any and all requirements or conditions of the Certificate;
8. Failed to submit a timely or complete
				periodic report within 180 days following the date the report is due pursuant
				to O.C.G.A. §
											31-6-70 and as otherwise required
				by Ga. Comp. R. & Regs. r.
				111-2-2-.04;
9. Failed repeatedly to pay any fines or
				moneys due to the Department;
10.
				Failed to maintain minimum quality of care standards that are outlined within
				the Certificate as granted; or
11.
				Failed to participate as a provider of medical assistance for Medicaid purposes
				if made a condition of the Certificate as granted pursuant to O.C.G.A. §
											31-6-45.2(a).
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-.06 - Application for Certificate of Need

Current through Rules and Regulations filed through June 27, 2024
(1)
Letter of Intent.
Beginning
				July 15, 2008, all persons who wish to submit an application for a Certificate
				of Need for a new institutional health service or health care facility, as
				provided in O.C.G.A. §
									31-6-40(a) and
				(b), must submit a letter of intent notifying
				the Department of their intent to do so at least thirty (30) days prior to
				submission of the Certificate of Need application. The notice must be in
				writing, must be submitted via the Department's web portal, and must contain
				the following information:
(a) Name and
				address of the legal applicant;
(b)
				Person to whom inquiries must be addressed;
(c) Name, address of facility, if different
				from legal applicant;
(d) Proposed
				project site location with specificity;
(e) Brief summary description of
				proposal;
(f) Proposed service
				area; and
(g) Cost of the project.
The Department will not accept any notices of intent
				  submitted by either telephone, facsimile, or electronic mail, pursuant to Ga.
				  Comp. R. & Regs. r.
				  111-2-2-.06(6).
				  Beginning with the date referenced above, no Certificate of Need application
				  will be accepted without a previously filed letter of intent. The Certificate
				  of Need application must be submitted no later than thirty (30) calendar days
				  after the letter of intent has been received by the Department. In the event
				  that the thirtieth (30th) calendar day falls either on a weekend or a legal
				  holiday, the thirtieth (30th) calendar day shall become automatically the next
				  business day that is neither a weekend nor a legal holiday. If a Certificate of
				  Need application is not submitted as provided herein, it will not be accepted
				  and an applicant filing an application beyond the time period specified will be
				  required to submit a new letter of intent in the manner specified above.
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-.11 - Service-Specific Review Considerations Generally

Current through Rules and Regulations filed through June 27, 2024
(1) The Department has adopted the following
				service-specific requirements and review considerations:
(a) Acute Care and Acute Care-Related Rules:
1. Short-Stay General Hospital Services, Ga.
				Comp. R. & Regs. r.
				111-2-2-.20;
2. Adult Cardiac Catheterization Services,
				Ga. Comp. R. & Regs. r.
				111-2-2-.21;
3. Open Heart Surgical Services, Ga. Comp. R.
				& Regs. r.
				111-2-2-.22;
4. Pediatric Cardiac Catheterization and Open
				Heart Services, Ga. Comp. R. & Regs. r.
				111-2-2-.23;
5. Perinatal Services, Ga. Comp. R. &
				Regs. r. 111-2-2-.24;
6. Freestanding Birthing Center Services, Ga.
				Comp. R. & Regs. r.
				111-2-2-.25; and
7. Psychiatric and Substance Abuse Inpatient
				Services, Ga. Comp. R. & Regs. r.
				111-2-2-.26;
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-.20 - Specific Review Considerations for Short-Stay General Hospital Beds

Current through Rules and Regulations filed through June 27, 2024
(1)
Applicability
.
(a) A Certificate of Need will be required
				prior to the establishment of a new hospital, replacement of an existing
				hospital, or expansion of an existing hospital.
(b) The provisions in these Rules do not
				apply to the following situations:
1. bed
				replacements in existing hospital facilities which do not require a capital or
				equipment expenditure over the applicable dollar threshold; or
2. changing the physical location of existing
				beds within an existing facility regardless of cost; provided, however, that
				any project in excess of the applicable capital expenditure or equipment dollar
				threshold must be reviewed in accordance with the review considerations set
				forth in Ga. Comp. R. & Regs. r.
				111-2-2-.09; or
3. projects that are otherwise exempt from
				review pursuant to O.C.G.A. §
											31-6-47(a)(15).
(c) An existing hospital seeking
				an expansion to be used for new institutional health services, including
				perinatal services, rehabilitation services, or psychiatric and substance abuse
				services, must meet the applicable service-specific Rules found in this Chapter
				and, as a threshold matter, meet the need standards set forth in Ga. Comp. R.
				& Regs. r. 111-2-2-.20(3)(b)(3) but shall not be required to meet the other
				requirements in Ga. Comp. R. & Regs. r. 111-2-2-.20.
(d) A hospital that has been approved through
				the Certificate of Need process to use a certain number of short-stay hospital
				beds for long-term acute care ("LTAC") beds shall have such LTAC beds removed
				from the official inventory of available short-stay beds once the LTAC is
				certified by Medicare; provided, however, that such beds will revert to the
				hospital's official inventory of available short-stay beds at any point that
				the LTAC ceases operation or is no longer certified by Medicare. An application
				to use existing short-stay hospital beds for LTAC beds shall not be subject to
				the guidelines in Ga. Comp. R. & Regs. r. 111-2-2-.20.
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-.21 - Specific Review Considerations for Adult Cardiac Catheterization Services

Current through Rules and Regulations filed through June 27, 2024
(1)
Applicability.
(a) For Certificate of Need purposes, Adult
				Cardiac Catheterization Services is classified as a specialized service and is
				defined as a new institutional health service which must be delivered in a
				permanently fixed location in either an acute care hospital or in a diagnostic,
				treatment, or rehabilitation center ("DTRC"). A Certificate of Need will be
				required prior to the establishment of a new or expanded adult cardiac
				catheterization service, if not exempt as provided by O.C.G.A. §
										31-6-47(a)(21)
				and Ga. Comp. R. & Regs. r.
				111-2-2-.03(24).
(b) If the service will be provided within a
				licensed acute care hospital, the hospital shall be the applicant.
(c) If cardiac catheterization services will
				be provided in a DTRC, the organizational entity that develops the service
				shall be the applicant.
(d) Seeking
				and receiving approval from the Department under the provisions of Ga. Comp. R.
				& Regs. r.
				111-2-2-.21(3)(f)3.
				shall neither be considered a new adult cardiac catheterization service nor an
				expanded service. Additionally, the issuance of such an approval shall not be
				construed to be anything other than a time-limited approval to participate in
				the particular medical research trial specified in Ga. Comp. R. & Regs. r.
				111-2-2-.21(3)(f)(3).
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-.25 - Specific Review Considerations for Freestanding Birthing Centers

Current through Rules and Regulations filed through June 27, 2024
(1) A Certificate
				of Need for a proposed new freestanding birthing center will be issued only if
				the services to be provided are consistent with the philosophy of
				family-centered care as defined in the State Health Plan and if there is
				evidence of safe and quality service at a charge lower than charges for
				deliveries provided on an inpatient basis.
(2) The applicant must agree to meet the
				rules and regulations for the development and operation of birthing centers
				required by the Healthcare Facility Regulation Division.
(3) The applicant must provide evidence that
				the birthing center will function as part of the established regionalized
				system of perinatal care. This includes arrangements for referral of those
				clients who develop complications that make them ineligible for delivery at the
				birthing center.
(4) A birthing
				center must have a written agreement for transfer and emergency services with a
				backup hospital(s) that provides at least Level II perinatal services. Each
				physician practicing at the center must have admitting privileges at the backup
				hospital.
(5) It must be
				demonstrated that agreements for ambulance service are available. In emergency
				situations, the center must have the capability of transporting the adult
				and/or newborn patients to the backup hospital within 30 minutes from
				initiation of transfer to the arrival at the hospital.
O.C.G.A. §§
											31-2
et seq.,
31-6
et seq.
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-.31 - Specific Review Considerations for Personal Care Homes

Current through Rules and Regulations filed through June 27, 2024
(1)
Applicability.
A Certificate of Need for a personal care home will
				be required prior to the establishment of a new personal care home, of
				twenty-five beds or more, and the expansion of any personal care home which is
				or will be twenty-five beds or more.
(2)
Definitions.
(a) "Health planning area" for all personal
				care homes, means the geographic regions in Georgia defined in the State Health
				Plan or Component Plan.
(b)
				"Horizon Year" means the last year of a three-year projection period for need
				determinations for a personal care home.
(c) "Official State Health Component Plan"
				means the document related to personal care homes developed by the Department
				adopted by the State Health Strategies Council and approved by the Board of
				Community Health.
(d) "Personal
				care home" means a residential facility that is certified as a provider of
				medical assistance for Medicaid purposes pursuant to Article 7 of Chapter 4 of
				Title 49 having at least twenty-five (25) beds and providing, for compensation,
				protective care and oversight of ambulatory, non-related persons who need a
				monitored environment but who do not have injuries or disabilities which
				require chronic or convalescent care, including medical, nursing, or
				intermediate care. Personal care homes include those facilities which monitor
				daily residents' functioning and location, have the capability for crisis
				intervention, and provide supervision in areas of nutrition, medication, and
				provision of transient medical care. Such term does not include:
1. old age residences which are devoted to
				independent living units with kitchen facilities in which residents have the
				option of preparing and serving some or all of their own meals; or
2. boarding facilities that do not provide
				personal care.
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-.32 - Specific Review Considerations for Home Health Services

Current through Rules and Regulations filed through June 27, 2024
(1)
Applicability.
A Certificate of Need for a home health agency will
				be required prior to the establishment of a new home health agency or the
				expansion of the geographic service area of an existing home health agency
				unless such expansion is a result of a non-reviewable acquisition of another
				existing home health agency.
(2)
Definitions.
(a) "Home health
				agency" means a public agency or private organization, or a subdivision of such
				an agency or organization, which is primarily engaged in providing to
				individuals who are under a written plan of care of a physician, on a visiting
				basis in the place of residence used as such individual's home, part-time or
				intermittent nursing care provided by or under the supervision of a registered
				professional nurse, and one or more of the following services: physical
				therapy, occupational therapy, speech therapy, medical-social services under
				the direction of a physician, or part-time or intermittent services of a home
				health aide.
(b) "Horizon year"
				means the last year of the three-year projection period for need determinations
				for a new or expanded home health agency.
(c) "Geographic service area" means a
				grouping of specific counties within a planning area for which the home health
				agency is authorized to provide services to individuals residing in the
				specific counties pursuant to an existing or future Certificate of Need. For
				purposes of establishing a service area for a new home health agency, the
				geographic service area shall consist of any individual county or combination
				of contiguous counties which have an unmet need as determined through the
				numerical need formula or the exception. For purposes of an expansion of an
				existing agency, the geographic service area shall consist of an individual
				county or any combination of counties which have an unmet need, and which are
				within any planning area in which the home health agency already provides
				service; however, in no case may an existing home health agency apply to
				provide services outside the health planning areas in which its current
				geographic service area is located.
(d) "Nursing care" means such services
				provided by or under the supervision of a licensed registered professional
				nurse in accordance with a written plan of medical care by a physician. Such
				services shall be provided in accordance with the scope of nursing practice
				laws and associated rules.
(e)
				"Planning area" for all home agencies means the geographic regions in Georgia
				defined in the State Health Plan or Component Plan.
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-.34 - Specific Review Considerations for Traumatic Brain Injury Facilities

Current through Rules and Regulations filed through June 27, 2024
(1)
Applicability.
The following Rules apply to Traumatic Brain Injury
				Facilities defined herein as providing transitional living programs and/or
				lifelong living programs.
(a) A Certificate
				of Need shall be required prior to the establishment of a new or the expansion
				of an existing Transitional Living Program, if not exempt as provided by
				O.C.G.A. §
										31-6-47(a)(25)
				and Ga. Comp. R. & Regs. r.
				111-2-2-.03(28). An
				application for Certificate of Need for a new or expanded Transitional Living
				Program shall be reviewed under the General Review Considerations of Ga. Comp.
				R. & Regs. r.
				111-2-2-.09 and the service-specific
				review considerations of this Rule.
(b) A Certificate of Need shall be required
				prior to the establishment of a new or the expansion of an existing Life Long
				Living Program, if not exempt as provided by O.C.G.A. §
										31-6-47(a)(25)
				and Ga. Comp. R. & Regs. r.
				111-2-2-.03(28). An
				application for Certificate of Need for a new or expanded Life Long Living
				Program shall be reviewed under the General Review Considerations of Ga. Comp.
				R. & Regs. r.
				111-2-2-.09 and the service-specific
				review considerations of this Rule.
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-.35 - Specific Review Considerations for Comprehensive Inpatient Physical Rehabilitation Services

Current through Rules and Regulations filed through June 27, 2024
(1)
Applicability.
(a) A Certificate of Need shall be required
				prior to the establishment of a new or the expansion of an existing
				Comprehensive Inpatient Physical Rehabilitation Adult Program. An application
				for Certificate of Need for a new or expanded Comprehensive Inpatient Physical
				Rehabilitation Adult Program shall be reviewed under the General Review
				Considerations of Ga. Comp. R. & Regs. r.
				111-2-2-.09 and the service-specific
				review considerations of this Rule.
(b) A Certificate of Need shall be required
				prior to the establishment of a new or the expansion of an existing
				Comprehensive Inpatient Physical Rehabilitation Pediatric Program. An
				application for Certificate of Need for a new or expanded Comprehensive
				Inpatient Physical Rehabilitation Pediatric Program shall be reviewed under the
				General Review Considerations of Ga. Comp. R. & Regs. r.
				111-2-2-.09 and the service-specific
				review considerations of this Rule.
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-.40 - Specific Review Considerations for Ambulatory Surgery Services

Current through Rules and Regulations filed through June 27, 2024
(1)
Applicability
. For Certificate of Need purposes, an Ambulatory
				Surgery Service is considered a new institutional health service if it is to be
				offered in an ambulatory surgery facility ("ASF") or in a diagnostic,
				treatment, or rehabilitation center ("DTRC").
(a) If the ambulatory surgery service is or
				will be provided as "part of a hospital", the hospital's provision of such
				service is not subject to Certificate of Need review under this Rule. For
				purposes of this Rule, the following are always considered to be "part of a
				hospital":
a) if the service is located within
				a hospital; or
b) if the service is
				located in a building on the hospital's primary campus and that building, or
				relevant portion thereof, is included within the hospital's permit issued by
				the State's licensing agency, subject to determination by the Department. The
				Department also will make a determination of reviewability on a case-by-case
				basis in other situations involving hospitals.
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-.41 - Specific Review Considerations for Positron Emission Tomography Units

Current through Rules and Regulations filed through June 27, 2024
(1)
Applicability.
(a) A Certificate
				of Need shall be required for a new or expanded positron emission tomography
				("PET") unit.
(b) On or after
				January 1, 2008, the Department shall only consider and approve applications
				for dual modality PET units; stand-alone PET units shall not be
				approved.
(c) On or after January
				1, 2008, an applicant for a mobile unit site shall be the hospital or DTRC
				which has entered into an agreement to receive mobile services. The actual
				mobile service provider shall not be the applicant. The hospital or DTRC that
				is serviced by the mobile provider shall be responsible for the provision of
				annual surveys and the provision of information to the Department.
(d) On or after January 1, 2008, a mobile
				provider shall be required to obtain a CON only if the fair market value or
				purchase price of the unit and any and all functionally related equipment
				exceeds the equipment threshold. If the fair market value or purchase price
				exceeds the equipment threshold, the mobile provider shall apply for a
				Certificate of Need under the general review considerations of Ga. Comp. R.
				& Regs. r.
				111-2-2-.09(1).
(e) A Certificate of Need obtained by a
				hospital or DTRC to offer mobile PET services shall be valid for the provision
				of mobile PET services only. A hospital or DTRC approved to offer mobile PET
				services must obtain a separate CON prior to offering fixed PET
				services.
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-.42 - Specific Review Considerations for MegaVoltage Radiation Therapy Services/Units

Current through Rules and Regulations filed through June 27, 2024
(1)
Applicability.
(a) A Certificate of Need will be required
				for the establishment of any new or expanded MegaVoltage Radiation Therapy
				Service.
(b) MegaVoltage Radiation
				Therapy, including Stereotactic Radiosurgery (SRS) and Stereotactic Body
				Radiation Therapy (SBRT) may be conducted on non-special units or on special
				purpose units.
(c) A Certificate of
				Need will be required for the addition of a non-special MRT unit. An
				application for the addition of a non-special MRT unit shall address the
				standards contained in Ga. Comp. R. & Regs. r.
				111-2-2-.42(3) in
				addition to the general review considerations of Ga. Comp. R. & Regs. r.
				111-2-2-.09(1). A
				certificate holder who has been authorized to provide MRT service solely on a
				non-special unit may not provide service on a special purpose unit without
				obtaining a special purpose MRT Certificate of Need.
(d) A Certificate of Need will be required
				for the addition of a special purpose MRT unit. An application for the addition
				of a special purpose MRT unit shall address the standards contained in Ga.
				Comp. R. & Regs. r.
				111-2-2-.42(4) in
				addition to the general review considerations of Ga. Comp. R. & Regs. r.
				111-2-2-.09(1). A
				certificate holder who has been authorized to provide MRT service solely on a
				special purpose unit may not provide service on a non-special unit without
				obtaining a non-special MRT Certificate of Need.
(e) An application for the establishment of a
				new or expanded MegaVoltage Radiation Therapy Service with the addition of both
				non-special and special purpose MRT units shall address the standards of Ga.
				Comp. R. & Regs. r.
				111-2-2-.42(3),
				111-2-2-.42(4) and
				the general review considerations of Ga. Comp. R. & Regs. r.
				111-2-2-.09(1).
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-.43 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. Secs.
				  31-5A
et seq.
,
				  31-6
et
				  seq.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-2 - HEALTH PLANNING › Subject 111-2-4 - RURAL HOSPITAL ASSISTANCE ACT › Rule 111-2-4-.01 - Implementation

Current through Rules and Regulations filed through June 27, 2024
The Department of Community Health, Office of Rural Health
				  Services, is authorized to issue one or more request(s) for proposals, at the
				  discretion of the Department, to implement the Rural Hospital Assistance Act in
				  accordance with O.C.G.A. §
									31-7-94
et
				  seq.
O.C.G.A. Secs.
				  31-5
et seq.
,
				  31-7-94.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-6 - INDIGENT CARE TRUST FUND › Rule 111-3-6-.01 - Definitions

Current through Rules and Regulations filed through June 27, 2024
(1)
				"Disproportionate share hospital" means a hospital licensed in Georgia which
				meets the criteria established by the Department for designation as a hospital
				which serves a disproportionate number of low-income patients with special
				needs.
(2) "Medically indigent"
				means a person with an income no greater than 200 percent of the federal
				poverty level guidelines as published by the United States Department of Health
				and Human Services.
(3) "Trust
				Fund" means the Indigent Care Trust Fund created by O.C.G.A. Title 31, Chapter
				8, Article 6.
(4) "Private
				Hospital" means any hospital licensed in Georgia which is not a public
				hospital.
(5) "Public Hospital"
				means any hospital licensed in Georgia that is owned by the State of Georgia, a
				city, county, or an authority organized pursuant to the "Hospital Authorities
				Law," O.C.G.A. §
									31-7-70
et
				seq.
O.C.G.A. Secs.
				  31-8-155,
				  49-4-142.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-6 - INDIGENT CARE TRUST FUND › Rule 111-3-6-.04 - Open Records

Current through Rules and Regulations filed through June 27, 2024
All Department records related to the Indigent Care Trust
				  Fund shall be open for public inspection in accordance with the Open Records
				  Act, O.C.G.A. §
									50-18-70
et
				  seq.
O.C.G.A. Sec.
				  31-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-6 - INDIGENT CARE TRUST FUND › Rule 111-3-6-.05 - Applicability of Medical Assistance Generally

Current through Rules and Regulations filed through June 27, 2024
Except where inconsistent with O.C.G.A., Title 31, Chapter 4
				  8, Articles 6, 6A, and 6B (Indigent Care Trust Fund), the provisions of
				  O.C.G.A., Title 49, Chapter 4, Article 7 (Georgia Medical Assistance Act of
				  1977) shall apply to the Department in carrying out the purposes of the Trust
				  Fund.
O.C.G.A. Sec.
				  31-6.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-8 - ESTATE RECOVERY › Rule 111-3-8-.01 - Legal Authority

Current through Rules and Regulations filed through June 27, 2024
In accordance with Title XIX of the Social Security Act,
				  42 U.S.C. §
										1396p, the State of Georgia has defined a
				  process to recover the cost of medical assistance payments from the estates of
				  deceased Members. The Official Code of Georgia gives the state the authority to
				  recover these monies. O.C.G.A. §
									49-4-147.1. In addition, the
				  recovery methodology must adhere to statutory provisions of the Georgia Revised
				  Probate Code of 1998, O.C.G.A. Title 53.
O.C.G.A. §
											49-4-147.1.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-8 - ESTATE RECOVERY › Rule 111-3-8-.03 - Notification to Member or Their Heirs

Current through Rules and Regulations filed through June 27, 2024
(1) If a debt is due pursuant to this section
				from the estate of a Member, the administrator of the nursing facility,
				intermediate care facility for individuals with intellectual disabilities, or
				medical institution in which the Member resided at the time of their death, the
				Medicaid case manager for community based services and/or the personal
				representative, if applicable, shall report the death to the Department within
				thirty (30) days of the death of the Member.
(2) If the personal representative of an
				estate makes a distribution either in whole or in part of the property of an
				estate to the Heirs, next of kin, distributes, legatees, or devisees without
				having executed the obligations pursuant to this section, the personal
				representative may be held personally liable for the amount of medical
				assistance paid on behalf of the Member, for the full value of the property
				belonging to the estate which may have been in the custody or control of the
				personal representative.
(3) When
				the Department receives notification of an affected Medicaid Member's death, a
				written notice will be provided to any known personal representative and any
				known Heirs which:
(a) Explains the terms and
				conditions of estate recovery and refers to the applicable statute and
				regulations;
(b) Advises of the
				Department's intent to recover the value of Medicaid benefits correctly paid on
				the Member's behalf from the Member's estate and states the amount;
(c) Explains that the Department's recovery
				action may include filing a lien on real property when recovery is
				delayed;
(d) Explains that the
				Heirs may file an undue hardship waiver and the procedures and time frames for
				filing the waiver;
(e) Advises the
				Heirs of their right to a hearing and the method by which they may obtain a
				hearing; and
(f) Includes a
				statement advising the amount of the claim may increase if there are additional
				Medicaid claims that have not yet been processed.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-8 - ESTATE RECOVERY › Rule 111-3-8-.04 - Recovery for Payments Made on Behalf of Medicaid-Eligible Persons

Current through Rules and Regulations filed through June 27, 2024
(1) These
				regulations shall be construed and applied to further the intent of the
				Legislature to supplement Medicaid funds that are used to provide medical
				services to eligible persons. Estate recovery shall be accomplished by the
				Department or its agent filing a statement of claim against the estate or with
				the closest identifiable surviving family members of a deceased Medicaid Member
				or any person who has an interest in property of the deceased member. Recovery
				shall be made pursuant to federal authority in § 13612 of the Omnibus
				Budget Reconciliation Act of 1993 which amends § 1917(b)(1) of the Social
				Security Act, 42 U.S.C.
				1396p(b)(1).
(2) Adjustment or recovery for all medical
				assistance and/or services pursuant to the State Plan will be from Medicaid
				Members:
(a) Who, at the time of death, were
				any age and an inpatient in a nursing facility, intermediate care facility for
				individuals with intellectual disability, or other medical institution if the
				Member is required, as a condition of receiving services in the facility under
				the State Plan, to spend for costs of medical care all but a minimal amount of
				the person's income required for personal needs; or
(b) Who, at the time of death, were
				fifty-five (55) years of age or older when the Member received medical
				assistance, but only for medical services consisting of nursing facility
				services, personal care services, home and community based services, and
				hospital and prescription drug services provided to Members in nursing
				facilities or receiving home and community based services.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-8 - ESTATE RECOVERY › Rule 111-3-8-.05 - Recovery of Assistance; Probate

Current through Rules and Regulations filed through June 27, 2024
(1) After receipt of notice of the death of
				an affected Member, the Department will file a claim against the estate for the
				full value of the Medicaid benefits paid on behalf of the Member.
(2) No action to recover a debt due by the
				deceased Member shall be commenced against the personal representative until
				the expiration of six (6) months from the date of qualification of the first
				personal representative to serve.
(3) Notwithstanding any other law, a claim
				filed for recovery of Medicaid assistance has priority in order of payment from
				the estate over all other claims, except the following:
(a) Years support for the family;
(b) Funeral expenses in an amount not to
				exceed ten thousand dollars ($10,000). However, this amount is zero (0) if the
				deceased Member has prepaid funeral expenses that were excluded as a resource
				for Medicaid eligibility;
(c)
				Necessary expenses of administration;
(d) Reasonable expensed of the deceased
				Member's last illness; and
(e)
				Unpaid taxes or other debts due the state or the United States. The category of
				Medicaid Estate Recovery is a debt due the state.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-8 - ESTATE RECOVERY › Rule 111-3-8-.06 - Recovery of Assistance; No Estate

Current through Rules and Regulations filed through June 27, 2024
(1) The administrator of the program may
				present an affidavit to a financial institution requesting that the financial
				institution release account proceeds to recover the cost of services correctly
				provided to a Member. The affidavit shall include the following information:
(a) The name of the deceased Member;
(b) The name of any person who
				gave notice that the Member was a Medicaid Member and that person's
				relationship to the deceased Member;
(c) The name of the financial institution;
(d) The account number;
(e) A description of the claim for estate
				recovery; and
(f) The amount of
				funds to be recovered.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-8 - ESTATE RECOVERY › Rule 111-3-8-.07 - Imposition of Liens

Current through Rules and Regulations filed through June 27, 2024
(1) The basis for authority to impose liens
				is based on the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). The
				TEFRA lien law provides that the agency can place a Lien on the available real
				estate of a Member who enters a nursing home and is "permanently
				institutionalized."
(2) The state
				may place a Lien on the Member's home when there is not a reasonable
				expectation that the Member will return home and when none of the following
				persons are living in the home:
(a) The
				Member's spouse;
(b) A child under
				twenty-one (21) years of age;
(c) A
				disabled child of any age; or
(d) A
				sibling with an equity interest in the home who has lived in the home for at
				least one (1) year before the Member entered the nursing home, and is lawfully
				residing in such home. The sibling must provide the State with clear and
				convincing evidence which demonstrates residency on a continuous basis and the
				sibling's equity interest. Additionally, the sibling must demonstrate that he
				or she did not reside in any other residence except the Member's home during
				the period of time specified in this subparagraph (2)(d). The sibling has the
				burden of proof in all proceedings.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-8 - ESTATE RECOVERY › Rule 111-3-8-.08 - Hardship Waiver

Current through Rules and Regulations filed through June 27, 2024
(1) Hardship waivers will be submitted to the
				program administrator for review. The denial of a hardship waiver may be
				appealed as provided under the Administrative Procedures Act, O.C.G.A. §
									50-13-1 et. seq. The waiver is
				limited to the period in which the undue hardship exists.
(2) There is no hardship waiver provided at
				the time of lien placement against the real property of a deceased Medicaid
				Member. The equity interest of the heir will be considered to determine the
				percentage of the deceased member's interest in the property.
(3) Lien placement is utilized to delay
				recovery until such time as an exemption to recovery does not exist, or in the
				case of an undue hardship, until such time as the undue hardship no longer
				exists. The state's lien would be for the Medicaid benefits paid on behalf of
				the Member or the percentage of interest of the deceased Member at the time of
				sale, whichever is less.
(4)
				Recovery will be waived in whole or in part pursuant to Rule
				111-3-8-.08(1) of
				any estate or lien recovery when the requesting party is able to show, through
				clear and convincing evidence, that the state's pursuit of recovery subjects
				them to undue hardship. In determining whether an undue hardship exists, the
				following criteria will be used:
(a) The
				asset to be recovered is an income producing farm and sole income source of one
				or more of the Heirs and the annual gross income is limited to $25,000 or less
				and is not merely rental income; or
(b) The recovery of assets would cause the
				applicant to become eligible for needs based governmental public assistance
				based on need and/or medical assistance programs.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-9 - HOSPITAL PROVIDER PAYMENT PROGRAM › Rule 111-3-9-.01 - Definitions

Current through Rules and Regulations filed through June 27, 2024
As used in Chapter 111-3-9:
(1) "Board" means the Board of Community
				Health, the body created under O.C.G.A. §
									31-2-3, appointed by the Governor,
				that establishes the general policy to be followed by the Department of
				Community Health.
(2) "Department"
				means the Department of Community Health established under O.C.G.A. §
									31-2-1.
(3) "Hospital" means an institution licensed
				pursuant to Chapter 7 of Title 31, which is primarily engaged in providing to
				inpatients, by or under the supervision of physicians, diagnostic services and
				therapeutic services for medical diagnosis, treatment, and care of injured,
				disabled, or sick persons or rehabilitation services for the rehabilitation of
				injured, disabled, or sick persons. Such term includes public, private,
				rehabilitative, geriatric, osteopathic, and other specialty hospitals but shall
				not include psychiatric hospitals, which shall of O.C.G.A. §
									37-3-1, critical access hospitals
				as defined in paragraph (3) of O.C.G.A. §
									33-21A-2, or any state owned or
				state operated hospitals.
(4) "Net
				Patient Revenue" means the total gross patient revenue of a Hospital less
				contractual adjustments; charity care; bad debt; Hill-Burton commitments;
				indigent care as defined by and calculated in the Department's annual Hospital
				Financial Survey; and gross patient revenues and contractual adjustments
				realized pursuant to section 1902(a)(10)(A)(i)(VIII) of the Social Security
				Act.
(5) "Provider Payment" means a
				payment assessed by the Department pursuant to this Chapter for the privilege
				of operating a Hospital.
(6)
				"Segregated Account" means an account for the dedication and deposit of
				Provider Payments which is established within the Trust Fund.
(7) "State Plan Amendment" means all
				documentation submitted by the Commissioner, on behalf of the Department, to
				and for approval by the Secretary of Health and Human Services pursuant to
				Title XIX of the federal Social Security Act of 1935, as amended.
(8) "Trauma Center" means a Hospital
				designated by the Department of Public Health as a Level I, II, III or IV
				Trauma Center.
(9) "Trust Fund"
				means the Indigent Care Trust Fund created by Article 6 of Chapter 8 of Title
				31.
(10) "Waiver" means a waiver of
				the requirements for permissible health care related taxes, as provided for in
				42 C.F.R. §
										433.68.
Act I of the 2013
				  Session of the Georgia General Assembly.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-9 - HOSPITAL PROVIDER PAYMENT PROGRAM › Rule 111-3-9-.03 - Use of Provider Payments

Current through Rules and Regulations filed through June 27, 2024
(1) The Department shall collect the Provider
				Payments imposed pursuant to this Chapter. All revenues raised pursuant to this
				Chapter shall be deposited into the Segregated Account. Such funds shall be
				dedicated and used for the sole purpose of obtaining federal financial
				participation for medical assistance payments to Hospitals and other providers
				on behalf of Medicaid recipients pursuant to Article 7 of Chapter 4 of Title
				49.
(2) Revenues appropriated to
				the Department by the General Assembly pursuant to Article 6C of Chapter 8 of
				Title 31 shall be used to match federal funds that are available for the
				purpose for which such funds have been appropriated.
(3) In recognition of the Provider Payments
				made by Hospitals pursuant to this Chapter, the Department shall add 11.88
				percent to hospital inpatient base rates, capital add-on rates, graduate
				medical education add-on rates, outlier per case payments and outpatient
				payment rates.
(4) The Department
				may conduct an annual review of the percentage defined in paragraph 3 and may
				make prospective adjustments to such percentage to ensure the amount of the
				add-on payments to Hospitals are substantially equivalent in the aggregate to
				the total amount of Provider Payments made by Hospitals pursuant to this
				Chapter.
Act I of the 2013
				  Session of the Georgia General Assembly.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-9 - HOSPITAL PROVIDER PAYMENT PROGRAM › Rule 111-3-9-.04 - Effective Date

Current through Rules and Regulations filed through June 27, 2024
Upon the adoption by the Board, Chapter 111-3-9 shall become
				  effective on July 1, 2013.
Act I of the 2013
				  Session of the Georgia General Assembly.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-10 - HOSPITAL MEDICAID FINANCING PROGRAM › Rule 111-3-10-.03 - Use of Provider Payments

Current through Rules and Regulations filed through June 27, 2024
(1) The Department shall collect the Provider
				Payments imposed pursuant to this Chapter. All revenues raised pursuant to this
				Chapter shall be deposited into the Segregated Account. Such funds shall be
				dedicated and used for the sole purpose of obtaining federal financial
				participation for medical assistance payments to Non-Governmental Hospitals and
				Long Term Acute Care Hospitals on behalf of Medicaid recipients pursuant to
				Article 7 of Chapter 4 of Title 49. Such payments to Non-Governmental Hospitals
				and Long Term Acute Care Hospitals may include, among other things:
(a) general Medicaid rate
				increases;
(b) targeted payments
				for higher acuity Medicaid beneficiaries; and/or
(c) targeted payments for specific services
				such as organ transplant, certified breast or cancer centers, psychiatric,
				telemedicine or other services.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-10 - HOSPITAL MEDICAID FINANCING PROGRAM › Rule 111-3-10-.04 - Advisory Committee

Current through Rules and Regulations filed through June 27, 2024
(1) The Advisory Committee shall develop and
				recommend to the Department new and amended rules, state plan amendments and
				waivers for the implementation of any provider payments established pursuant to
				Act 1 of the 2013 Georgia General Assembly.
(2) The Committee shall develop and recommend
				to the Department the methodology to calculate the annual UPL applicable to
				hospital payments under federal Medicaid law.
Act I of the 2013
				  Session of the Georgia General Assembly.
Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-10 - HOSPITAL MEDICAID FINANCING PROGRAM › Rule 111-3-10-.05 - Effective Date

Current through Rules and Regulations filed through June 27, 2024
Upon the adoption by the Board, Chapter 111-3-10 shall become
				  effective on July 1, 2013;
provided however, the Advisory Committee which was
				  created by Executive Order of the
Governor became effective on March 5,
				  2013.
Act I of the 2013
				  Session of the Georgia General Assembly.