Georgia’s Certificate of Need laws require potential healthcare providers to receive permission from the sate, and at times, their competition.
Georgia requires a Certificate of Need for most healthcare providers. Under current law, the application fee for a CON in Georgia ranges from $1,000- $50,000. Georgia’s CON program was established as state law by the General Assembly in 1979. Notably, competitors were not allowed to challenge certificate of need applications at the state level until the law was amended in 1983. Since then, attempts to reform, modernize and even repeal the program have been met with varying degrees of success.
In Georgia, a Certificate of Need is required if hospitals or destination cancer hospitals wish to increase beds. In the non-hospital setting, a CON is required for increasing beds in skilled nursing facilities, intermediate care facilities, personal care homes, ASC’s, obstetrical facilities, freestanding emergency departments, and diagnostic treatment or rehabilitation centers.
A CON is also required for the construction, development, expansion, or relocation of hospitals, special care units, skilled nursing facilities, intermediate care facilities, personal care homes, ASC’s, obstetrical facilities, freestanding emergency departments, health maintenance organizations, and diagnostic, treatment, or rehabilitation centers. Healthcare services that require a CON include imaging, biliary, lithotripsy, surgery, intensive care, coronary care, pediatrics,gynecology, obstetrics, general, medical care, medical surgical care, and patient, nursing, cardiac catheterization, open heart, surgery, inpatient rehabilitation, alcohol or drug abuse, services, and mental health services.
Providers who wish to challenge the state’s CON decisions, whether in support of or in opposition to the proposed project, have the option to pursue administrative and legal challenges. This has often meant years added to the process for projects to move forward.
The CON process
An analysis from 2017-2022 found:
- When a competitor objects to an application, the odds of denial more than double from 20 percent to about 50 percent.
- Every additional party opposed to the application increases the odds of denial by about 11 percent.
- Any opposition to an application adds 234 days to the wait time for a decision, but competitor opposition adds about 520 days to the wait time.
- Each additional party opposed to the application adds another 129 days.
- The cost of the project is not statistically significantly related to either approval or wait times.
- There don’t appear to be any statistically significant trends over time in approval or wait time.
However, even this analysis does not present a comprehensive picture of the barriers to entry inherent within Georgia’s CON program. While many proponents of the current system will offer that it is working as intended and that providers should just “file for a CON”, this often does not represent a realistic route for most applicants that are not health systems or hospitals.
Many smaller physician offices choose to forgo equipment purchases or upgrades out of an acceptance they will not be able to compete with larger competitors willing to spend time and money on exacting regulatory barriers and legal appeals.