Georgia Certificate of Need (CON) Introduction

Like many other states, Georgia has an extensive CON process in place for healthcare services and facilities. Winning approval for a CON application is often a time consuming and difficult undertaking. Working with RPC provides clients with a team of consultants with experience working with CON projects.

When working on a CON project, RPC can prepare the entire CON application or sections of the application as the client prefers. When the client is defining the project and deciding whether to file an application, RPC can help assess the market and regulatory situation to determine the relative likelihood of success for a project. RPC not only works to create a thorough market, need and financial analysis, but also works seamlessly with the client’s staff, architects, engineers and other outside consultants to create a solid CON application.

RPC is led by Ron Luke, JD, PhD, who has prepared CON applications and presented testimony in CON hearings since 1981 in more than 20 states.  RPC’s work on CON projects includes the opening of new acute care hospitals, nursing homes, hospices, physical rehabilitation and psychiatric specialty hospitals, ambulatory surgery facilities, the relocation and addition of beds, and the acquisition of major medical equipment. Working with RPC during the CON process gives the applicant the advantage of a skilled, experienced team that can provide expert advice and produce an effective CON application.

Contents last updated on July 9, 2024

Recent Changes to Georgia’s CON Program

On April 19, 2024, the Governor of Georgia signed House Bill 1339 into law. This new law introduces new exemptions to the CON process and modifies existing CON regulations. Here’s what you need to know about the recent legislative changes and what to expect moving forward.

Georgia ASC Exemptions

Single-specialty ASCs that are owned and operated by an individual physician or a single practice of physicians in a single specialty are exempt from Certificate of Need (CON) requirements if their capital expenditures do not exceed $2.5 million, or if it is the sole single-specialty ASC in the county owned by that practice with no more than two operating rooms (ORs). The definition of single-specialty ASCs has been revised to allow physicians who are not members of the practice owning the facility to perform surgeries, provided they share the same specialty as the practice that owns the ASC. Additionally, it now permits an outside entity to manage these ASCs.

The definition of joint-venture ASCs has been updated to allow non-member physicians of the owning practice to perform surgeries, given they are of the same specialty as the physician practice that partially owns the ASC. These joint-venture ASCs are exempt from CON review if capital expenditures are under $5 million and must be jointly owned by a hospital in the same county as the physicians.

Other Expanded CON Exemptions

The legislation significantly expanded CON exemptions, which now include:

  • Unlimited capital expenditures by an existing hospital for its primary campus for various services such as operating rooms and procedure rooms. The limit for such expenditures was previously $10 Million.
    • This exemption does not apply to additional inpatient beds.
  • New or expanded psychiatric and substance abuse inpatient programs serving Medicaid and uninsured patients.
  • New or expanded perinatal services by hospitals in a rural county serving Medicaid providers, with an affiliation agreement with a Level III perinatal provider.
  • The ability to transfer existing beds between campuses within the same system, provided they are within 15 miles of each other.
  • Establishment of birthing centers
  • Establishment of new acute care hospitals in rural counties that will achieve a teaching status or obtain a trauma center designation (Level I, II, III or IV) within 36 months.
  • The legislation provides an exemption for Morehouse School of Medicine to open a hospital in Atlanta, aiming to substitute some services previously provided by the now-closed Atlanta Medical Center.
  • The legislation provides an exemption for the reopening of recently shuttered rural hospitals, particularly targeting the replacement of a hospital in Cuthbert, GA.

Looking Ahead

The Department of Community Health is directed to work with the Office of Legislative Counsel to propose further changes to the CON statutes. These recommendations must be submitted by December 1, 2024, indicating that we can anticipate another round of CON-related legislation in  2025.

Next Legislative Session

2025

State Agencies

Georgia Department of Community Health
Through their Office of Health Planning, the Department oversees and administers the CON process from pre-application consultation to review and decision.

Office of Health Planning
Georgia Department of Community Health (DCH), Healthcare Facility Regulation Division (HFR) Office of Health Planning
2 Martin Luther King Jr. Drive SE East Tower, Atlanta, GA 30334
(404) 656-4507

Certificate of Need Appeal Panel
This panel is comprised of independent hearing officers (attorneys appointed by the Governor) who conduct appeal hearings to review the Department’s initial decision to grant or deny a CON.  The hearing officer’s decision becomes the Department’s final decision.

Facilities and Services that Require CON

The purpose of Georgia’s CON process is to ensure adequate facilities and health care services are developed in an orderly and economical manner, and are available to all Georgians. The CON program aims to contain health costs, promote economic value, ensure compatibility of services with the needs of the population, and prevent duplication of services.

Projects that require a CON include:

  • New hospitals, including general, acute-care and specialty hospitals, except those that are in a rural county and will achieve teaching status or trauma center designation
  • New or expanding nursing home and home health agencies
  • Multi-specialty ambulatory surgery centers
  • Single-specialty ambulatory surgery centers owned by a single physician practice with a capital expenditure amount exceeding $4,251,934
  • Joint venture ambulatory surgery centers with a capital cost exceeding $8,502,788
  • Providers of radiation therapy, positron emission tomography, open heart surgery, and neonatal services
  • Major medical equipment purchases or leases (e.g. MRI, CT scanners) that exceed the equipment threshold of $3,052,561
  • Capital expenditures by a hospital for additional inpatient beds
  • Before a health care facility can offer a health care service, which was not provided on a regular basis during the previous 12-month period, or add additional beds.

Georgia requires a CON application for any services or equipment that have proposed costs over the published thresholds. CON thresholds are updated annually, effective July 1st of that year. Thresholds can be found at the following link: https://dch.georgia.gov/con-thresholds

Certificate of Need Process Milestones

The Department groups applications into batching cycles.  Each cycle occurs at least twice a year. Applications with no specific batching cycle may be filed at any time.

  1. Notice of Intent
    An applicant wishing to submit an application for a certificate of need for a new institutional health service or health facility must submit a Letter of Intent (LOI) 30 days prior to submitting the CON application. The LOI will include the applicant’s contact information, specific project location, proposed service area, description of the proposed project, and cost estimate.
  2. Application Submission
    An original signed application and one signed copy must be submitted by 3:00 pm 30 days after the Letter of Intent.  Application contents include relevant data, information, and assurances required by the Department.  The applicant responds to inquiries about the site, state and local codes and ordinances, detailed project description, project justification (need by the population served), staffing, operation, financial information, cost containment and quality of care considerations, project design, construction schedule, and cost estimate.
  3. Review for Completeness
    The Department examines an application before it can be fully reviewed. The applicant will receive notification from the Department on the application’s completion status or a request for more information within ten (10) business days following submission.  The Department will deem an application to be withdrawn if the applicant fails to provide the Department with information requested on a notice of incompleteness within two calendar months after the date of the original letter notifying the applicant of the information necessary for completeness. Following receipt of additional information, the Department sends notice of completion within ten days. Once deemed complete, the Department releases a public notice to a newspaper of general circulation, county and municipal governments of the project area, and the appropriate Regional Development Center.
  4. Beginning of Review Process
    Once deemed “complete” and notices sent, the Department begins to review the application.  Reviews take between 60 and 120 days from the date of notification to the decision. However, if an additional application for a similar service area is submitted within 30 days of the initial application being deemed “complete”, both may be joined together in a review cycle. In such a case, the Department will notify all applicants, and the new timeline for the Department’s decision will be 120 days from the date the latest-joined application was deemed complete.
  5. Public Hearing
    A request for a public hearing can be filed in the first twenty (20) days of the review period and must be signed by at least 50 residents of the area where the project is located.  The request must show good cause: effect on (access to) existing services, strong conflicting community viewpoints, etc.  Notification of the hearing is provided in local newspapers two weeks before the hearing.  Any person may offer testimony or evidence.
  6. Second Chance
    During the first two months of the review period, the Department can notify the applicant of any factors that create a potential for denial of the application.  The applicant can meet with the Department on or before the 60th day of the review period.  Opposing parties cannot attend the 60-day meeting. Any additional information requested must be submitted by the 75th day of the review period.
  7. Department Review and Decision
    The Department considers the standard criteria and uses the State Office of Planning and Budget, Medicare/Medicaid Cost Reports, and questionnaires or surveys initiated by the Department as sources for analysis.  The Department provides written notification of its decision to issue or deny the CON within 120 days of the application being deemed complete.  The decision includes a detailed statement of findings and information about an appeal hearing. A copy is sent to all applicants, the Regional Development Center, and the local government. If approved, the applicant has 12 months from the date of approval to implement the proposed project.
  8. Appeal
    Any applicant, competing applicant in the same batching cycle, opposing facility, or affected county/municipal government has the right to call (by written request) and intervene in an initial administrative appeal hearing within 30 days of the Department’s decision.  The hearing officer schedules the hearing (between 60 and 120 days after request) and notifies all affected parties.  The hearing is conducted as a full evidentiary hearing.  Within 30 days of the hearing’s conclusion, the officer renders a decision with written findings of fact and conclusions of law.  The hearing officer’s decision becomes the Department’s final decision on the 61st day following his or her decision.
  9. Commissioner Review
    Any party which disputes the decision of the hearing officer may file a written appeal to the Commissioner of the Department of Community Health within 30 days of the hearing officer’s decision.  The Commissioner or his designee can deem the hearing officer’s order as the final decision, modify the order, or reject it.
  10. Judicial Review
    Any party to the initial administrative appeal hearing (except the Department) may seek judicial review of the final decision. The Court may reverse or modify the final decision only if substantial rights of the appellant have been prejudiced because of the procedures followed by the Department, the hearing officer, or the Commissioner.
  11. Periodic Reports
    All CON-regulated facilities and services are required to complete and submit certain surveys annually and periodically to the Department.  The applicant must provide a progress report to the Department within 12 months of the effective date of the CON with information about construction and costs.

What Criteria are Used to Review a CON?

Georgia’s General Review Criteria are published in the Georgia Rules § 11-2-2-.09 and are briefly summarized below.

  1. Project is consistent with State Health Plan
  2. The population to be served has exhibited need for the proposed services
  3. Alternatives are not available, are not a less costly alternative, are not similarly utilized, or have not been addressed by a previous CON approval
  4. Project is financially feasible
  5. Effects on payors are reasonable
  6. Costs are reasonable, construction is economically designed
  7. Service or facility is financially and physically accessible to proposed service area residents and does not discriminate
    • Applicant accepts a reasonable share of total community burden for those unable to pay
    • Accepts medically indigent, Medicaid, Medicare and PeachCare patients, is committed to those programs
  8. Positive relationship to existing healthcare services in proposed service area
  9. Encourages efficient utilization of the facility proposing the service
  10. Providing services to residents outside service area is taken into account
  11. Any research or medical training efforts are taken into account
  12. Fosters improvement or innovations in delivery of health services or competition resulting in lower healthcare costs without a lesser quality of care
  13. Fosters special needs of HMOs
  14. Meets Department’s minimum quality standards
  15. Has access to necessary resources, including personnel
  16. Is an underrepresented health service 

There are additional service-specific review criteria that are accessible through the Department’s website, but all projects are reviewed according to the above general criteria.

Certificate of Need Application Filing Fee

Every application requires an accompanying filing fee:

  • Total project cost under $1,000,000; the fee is $1,000
  • Total project cost greater than $1,000,000; fee is 0.1% of total cost, not to exceed $50,000

Review of cost overruns is computed as above for the amount of the overrun.  An appeal fee is $7,500.

Additional Sources

(links good as of June 2024)

Georgia Department of Community Health CON Program
https://dch.georgia.gov/divisionsoffices/office-health-planning/certificate-need-con

CON Statute (O.C.G.A. § 31-6-3)
https://law.justia.com/codes/georgia/2010/title-31/chapter-6/article-3/

CON Rules and State Health Plans

https://dch.georgia.gov/divisionsoffices/office-health-planning/certificate-need-con/state-health-plans-and-con-rules

Need Projections
https://dch.georgia.gov/need-projections

Application Forms

https://dch.georgia.gov/divisionsoffices/office-health-planning/office-health-planning-submission-portal/con-applications

House Bill 1339

https://www.legis.ga.gov/legislation/67221

Contact RPC Consulting

Should you or your client need an expert team to help you with the Georgia Certificate of Need process (CON) please contact Regulatory Practice Manager Darcy Schaeffer, MLS at 512‑371‑8011.

Disclaimer: The information on this page has been compiled by RPC based on sources believed to be reliable. It was updated in July 2024. Where possible we have had the material reviewed by state CON officials or others knowledgeable of the state’s CON program. The information is not offered as legal advice. A state may change its rules, forms and procedures at any time and RPC offers no assurance that the information will be correct on the date it is viewed. Therefore the reader is urged to use this information only as a starting point for any CON application and to speak with state officials or seek legal or consulting advice early in the process.