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-.30 - Specific Review Considerations for Skilled Nursing and Intermediate Care Facilities
Universal Citation: GA Rules and Regs r 111-2-2-.30
Current through Rules and Regulations filed through March 20, 2024
(1) Applicability. A Certificate of Need will be required prior to the establishment of a new or expanded skilled nursing facility, intermediate care facility, or an intermingled facility.
(2) Definitions.
(a) "Horizon year"
means the last year of the three-year projection period for need determinations
for a nursing facility.
(b)
"Hospital-based nursing facility" means a nursing facility which meets the
current definition of "Hospital-Based Nursing Facilities" as defined in the
current Policies and Procedures for Nursing Facility Services by the Georgia
Department of Community Health, Division of Medical Assistance. A new
hospital-based nursing facility can only result from conversion of existing
inpatient space on the hospital's campus.
(c) "Intermediate care facility" ("ICF")
means an institution which provides, on a regular basis, health related care
and services to individuals who do not require the degree of care and treatment
which a hospital or skilled nursing facility is designed to provide but who,
because of their mental or physical condition, require health related care and
services beyond the provision of room and board.
(d) "Intermingled facility" means a nursing
facility that provides both skilled intermediate levels of care.
(e) "Medicare distinct part skilled nursing
unit" means a unit which meets the current definition of "Distinct Part of an
Institution as SNF" as defined in the current Medicare Part A Intermediary
Manual by the Centers for Medicare and Medicaid Services ("CMS") of the U.S
Department of Health and Human Services.
(f) "Nursing facility" means a facility
classified as either a skilled nursing facility, an intermediate care facility
or an intermingled facility which admits patients by medical referral and
provides for continuous medical supervision via 24-hour-a-day nursing care and
related services in addition to food, shelter, and personal care.
(g) "Official State Health Component Plan"
means the document related to the above-named services developed by the
Department, established by the Georgia State Health Strategies Council, and
adopted by the Board of Community Health.
(h) "Planning area" for all nursing
facilities, with the exception of state nursing facilities, means the
geographic regions in Georgia defined in the "Official State Health Component
Plan". "Planning area for a state nursing facility" means the State of
Georgia.
(i) "Retirement
community-based nursing facility" means a nursing facility which operates as a
lesser part of a retirement community which is a planned, age-restricted,
congregate living development which offers housing, recreation, security,
dietary services, and shared living areas accessible to all
residents.
(j) "Skilled nursing
facility" ("SNF") means a public or private institution or a distinct part of
an institution which is primarily engaged in providing inpatient skilled
nursing care and related services for patients who require medical or nursing
care or rehabilitation services for the rehabilitation of the injured, disabled
or sick persons.
(k) "State nursing
facility" is a facility that meets the definition of a Nursing Facility as
defined above and is owned and operated by a branch or branches of government
of the State of Georgia.
(l) "Urban
county" means a county with a projected population for the horizon year of
100,000 or more and population density for that year of 200 or more people per
square mile. All other counties are "rural".
(3) Standards.
(a) The need for a new or expanded nursing
facility in a planning area in the horizon year shall be determined through
application of a numerical, supply-oriented need method and an assessment of
current planning area utilization designed to measure demand for services.
1. The numerical need for a new or expanded
nursing facility in any planning area in the horizon year shall be determined
by a population-based formula which is a sum of the following:
(i) a ratio of 0.43 beds per 1,000 projected
horizon year Resident population age 64 and younger;
(ii) a ratio of 9.77 beds per 1,000 projected
horizon year Resident population age 65 through 74;
(iii) a ratio of 32.5 beds per 1,000
projected horizon year Resident population age 75 through 84; and
(iv) a ratio of 120.00 beds per 1,000
projected horizon year Resident population age 85 and older.
2. The demand for services in each
planning area will be measured by the cumulative facility bed utilization rate
during the most recent survey year period. The utilization rate shall be
determined by dividing the actual bed days of resident care by the bed days
available for resident care.
3. In
order to establish need for a new or expanded nursing facility in any planning
area, the utilization rate in that planning area shall have equaled or exceeded
ninety-five percent (95%) during the most recent survey year.
(b) The required bed size for a
new nursing facility in a rural or urban county is as follows: (Rural/urban
designation shall be based on the county within which the proposed facility is
to be located.)
1. A freestanding nursing
facility in a rural county: a minimum of 60 beds;
2. A freestanding nursing facility in an
urban county: a minimum of 100 beds;
3. A hospital-based nursing facility in a
rural county: a minimum of 10 beds and a maximum of 20 beds;
4. A hospital-based nursing facility in an
urban county: a minimum of 20 beds and a maximum of 40 beds;
5. A retirement community-based nursing
facility: 1 nursing home bed for each 4 residential units, with a minimum of 20
beds and a maximum of 30 beds.
(c) In competing applications, favorable
consideration may be given for the inclusion of services for special needs
populations, such as but not limited to, persons with Alzheimer's Disease and
related disorders, medically fragile children, or persons with HIV/AIDS. An
applicant must document a need for the service and that it is cost
effective.
(d) The Department may
allow an exception to Ga. Comp. R. & Regs. r.
111-2-2-.30(3)(a)
under the following circumstances:
1. the
establishment of a new Medicare distinct part skilled nursing unit if the
proposed unit is to be in a county that does not have an existing Medicare
unit; and if the applicant can document that there is limited access in the
proposed planning area for skilled nursing services for Medicare patients.
Limited access means that existing nursing facilities have not provided the
proposed services in response to a demonstrated demand for the services over
the three (3) most recent years. The implementation of an approved Certificate
of Need will be valid only if the proposed beds will be limited to Medicare
recipients. This exception is available to existing nursing facilities and
hospitals; or
2. the applicant for
a new or expanded nursing facility can show that there is limited access in the
proposed geographic service area for special groups such as, but not limited to
medically fragile children and HIV/AIDS patients. Limited access means that
existing nursing facilities have not provided the proposed services in response
to a demonstrated demand for the services over the three (3) most recent
years.
(e) An applicant
for a new or expanded facility must document provision of continuity of care by
meeting each of the following:
1. An
applicant shall provide a community linkage plan which demonstrates factors
such as, but not limited to, referral arrangements with appropriate services of
the healthcare system and working agreements with other related community
services assuring continuity of care; and
2. An applicant shall document the existence
of proposed and/or existing referral agreements with a nearby hospital to
provide emergency services and acute-care services to residents of the proposed
or existing facility; and
3. An
applicant shall provide existing or proposed rehabilitation plans for services
to facility residents; and
4. An
applicant shall provide existing or proposed discharge planning
policies.
(f) An
applicant for a new or expanded nursing facility must provide evidence of the
intent to meet all appropriate requirements regarding quality of care as
follows:
1. An applicant shall provide a
written statement of its intent to comply with all appropriate licensure
requirements and operational procedures required by the Healthcare Facility
Regulation Division;
2. An
applicant shall provide evidence that there are no uncorrected operational
standards in any existing Georgia nursing homes owned and/or operated by the
applicant or by the applicant's parent organization. Plans to correct physical
plant deficiencies in the applying facility must be included in the
application;
3. An applicant and
any facility owned and/or operated by the applicant or its parent organization
shall have no previous conviction or Medicaid or Medicare fraud;
4. An applicant shall demonstrate the intent
and ability to recruit, hire and retain qualified personnel to meet the current
Medicaid certification requirements of the Department's Division of Medical
Assistance for the services proposed to be provided and that such personnel are
available in the proposed geographic service area;
5. An applicant shall provide a plan for a
comprehensive quality improvement program that includes, but is not limited to,
procedures and plans for staff training and a program to monitor specific
quality indicators and measure the facility's performance; accordingly,
and
6. In competing applications,
favorable consideration will be given to an applicant that provides evidence of
the ability to meet accreditation requirements of appropriate accreditation
agencies within two years after the facility becomes operational.
(g) An applicant or a new or
expanded facility must provide evidence of meeting the following standards
pertaining to financial accessibility:
1. An
applicant shall provide a written commitment of intent to participate in the
Medicaid and Medicare programs if appropriate;
2. An applicant shall demonstrate a case-mix
of Medicaid, Medicare and private pay patients; and
3. Document policies and practices of
nondiscrimination by past performance of the applicant or its parent
organization.
(h) A new
or expanded state nursing facility may be exempted from the provisions of Ga.
Comp. R. & Regs. r.
111-2-2-.30(3)(a), (b), (c), (d), and
(g) when the facility meets all of the
following criteria:
1. documentation that the
proposed facility will meet the definition of a state nursing facility as
defined in Ga. Comp. R. & Regs. r.
111-2-2-.30(1)
((k);
2. documentation that the
applicant will admit patients from any of Georgia's counties with a primary
focus on a pre-designated, multi-county service area or region;
3. the facility intends to become accessible
to patients whose care, because of income and other limitations, would normally
come under the jurisdiction of the state; and
4. such other considerations as may be
considered necessary by the Department at the time of the
application.
(i) An
applicant for a new or expanded nursing facility shall document an agreement to
provide Department requested information and statistical data related to the
operation and provision of nursing facility services and to report that data to
the Department in the time frame and format requested by the
Department.
O.C.G.A. §§ 31-2et seq., 31-6 et seq.
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