31-1-1. Definitions.

Except as specifically provided otherwise, as used in this title, the term:

1. "Board" means the Board of Public Health.
2. "Commissioner" means the commissioner of public health.
3. "Department" means the Department of Public Health. (Code 1981, § 31-1-1 ; Ga. L. 2008, p. 12, § 2-7/SB 433; Ga. L. 2009, p. 453, § 1-2/HB 228; Ga. L. 2011, p. 705, § 3-5/HB 214.)

Editor's notes. - This Code section was created as part of the Code revision and was thus enacted by Ga. L. 1981, Ex. Sess., p. 8 (Code enactment Act).

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-1-2. Use of flammable materials in eyeglass frames; delivery of completed work by offices, companies, or laboratories; penalty.

1. No person shall distribute, sell, exchange, deliver, or have in his possession with intent to distribute, sell, exchange, or deliver in this state any prescription eyeglass frame or prescription sunglass frame containing any form of cellulose nitrate or other highly flammable material.
2. Optical offices, manufacturing companies, or laboratories which prepare lenses for prescription eyeglasses or sunglasses, including industrial safety eyewear, and which perform mechanical work upon inert materials in the preparation of such eyeglasses or sunglasses shall in every case deliver the completed product of their efforts only to the physician, optometrist, or licensed dispensing optician who ordered the work performed.
3. Any person who violates any provision of this Code section shall be guilty of a misdemeanor and, upon conviction thereof, shall be punished as follows: the first offense shall be punished by a fine of not more than $200.00; each subsequent offense shall be punished by a fine of not more than $500.00.

   (Code 1933, §§ 92A-1901, 92A-9931, enacted by Ga. L. 1970, p. 30, §§ 1, 2; Ga. L. 1973, p. 746, § 1; Ga. L. 1974, p. 515, §§ 1, 2.)

Cross references. - Dispensing opticians, T. 43, C. 29.

Optometrists, T. 43, C. 30.

Physicians, § 43-34-20 et seq.

31-1-3. Detection of hearing impairments in infants; evaluations.

1. It shall be the public policy of this state that newborn infants in certain high-risk categories be evaluated for the detection of hearing impairments in order to prevent many of the consequences of these disorders.
2. The department shall develop guidelines for evaluation and follow-up procedures for the detection of hearing impairments in infants determined by the department to be in those high-risk categories in which the likelihood of such impairments is greatest and shall develop rules and regulations to ensure that all such high-risk infants are evaluated within one year of their birth. No such evaluation shall be made as to any newborn infant if the parents or legal guardian of the child objects thereto on the grounds that such a test would conflict with their religious tenets or practices.

   (Code 1933, §§ 88-3301a, 88-3302a, enacted by Ga. L. 1978, p. 1726, § 1.)

31-1-3.1. Reporting disabled newborn persons; referral to treatment and rehabilitative services.

1. It is the intent of the General Assembly to ensure the registration by the department of disabled newborn persons in order that all such persons might obtain referral and other services provided by existing state agencies, departments, other organizations, and individuals.
2. As used in this Code section, the term "disabled newborn person" means a person less than 12 months old who is deaf, blind, or has a serious congenital defect as defined by the department.
3. Except as otherwise provided, every public and private health and social agency and every physician authorized to practice medicine in this state shall report to the department the name of any person such agency or physician has identified as being a disabled newborn person. The report shall be made within 48 hours after identification of that person and shall contain the name, age, address, type and extent of disability, social security number, if any, and such other information concerning that person as the department may require.
4. The department shall establish procedures whereby a disabled newborn person for whom a report is made under this Code section shall be referred with informed consent to appropriate public or private departments or agencies for treatment and rehabilitative services.
5. The department shall:
   1. Maintain records of reports, notifications, and referrals made under this chapter; and
   2. Maintain and update rosters of public and private departments or agencies which provide services to persons who have disabilities like those of disabled newborn persons and send copies of such rosters and an annual update thereof to each county board of health for those boards of health to make such rosters available to the public.
6. Statistical information collected under this Code section shall be available to any other federal or state agency or private organization concerned with disabilities of newborn persons, but no names or addresses will be provided without the consent of the immediate family or guardian of the disabled newborn person.
7. Any person or entity with whom the department enters into a contract after June 30, 1987, for services shall, as a condition of that contract, register with the department (formerly the Division of Public Health of the Department of Community Health) the various services that person or entity is capable of or is already providing to disabled newborn persons and persons having disabilities like those of disabled newborn persons for purposes of the roster of services the department maintains under paragraph (2) of subsection (e) of this Code section.
8. A person or entity which in good faith makes a report required by subsection (c) of this Code section shall be immune from civil and criminal liability therefor. (Code 1981, § 31-1-3.1 , enacted by Ga. L. 1987, p. 393, § 1; Ga. L. 1989, p. 14, § 31; Ga. L. 1995, p. 1302, §§ 13, 14; Ga. L. 1997, p. 1585, § 2; Ga. L. 2011, p. 705, § 5-9/HB 214.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2019, "chapter" was substituted for "article" near the end of paragraph (e)(1).

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-1-3.2. Hearing screenings for newborns.

1. The General Assembly finds, determines, and declares:
   1. That hearing loss occurs in newborn infants more frequently than any other health condition for which newborn infant screening is required;
   2. That 80 percent of the language ability of a child is established by the time the child is 18 months of age and that hearing is vitally important to the healthy development of such language skills;
   3. That early detection of hearing loss in a child and early intervention and treatment has been demonstrated to be highly effective in facilitating a child's healthy development in a manner consistent with the child's age and cognitive ability;
   4. That children with hearing loss who do not receive such early intervention and treatment frequently require special educational services and that such services are publicly funded for the vast majority of children with hearing needs in the state;
   5. That appropriate testing and identification of newborn infants with hearing loss will facilitate early intervention and treatment and may therefore serve the public purposes of promoting the healthy development of children and reducing public expenditure;
   6. The American Academy of Pediatrics, the American Speech-Language-Hearing Association, the American Academy of Audiology, and the American Academy of Otolaryngology, Head and Neck Surgery have recently endorsed the implementation of universal newborn hearing screenings and recommended that such screenings be performed in all birthing hospitals and coordinated by state departments of public health; and
   7. That consumers should be entitled to know whether the hospital at which they choose to deliver their infant provides newborn hearing screening.
2. As used in this Code section, the term "newborn infant" means an infant after delivery but before discharge from the hospital.
3. For reasons specified in subsection (a) of this Code section, the General Assembly determines that it would be beneficial and in the best interests of the development of the children of the state that newborn infants' hearing be screened.
4. Reserved.
5. It is the intent of the General Assembly that, by July 1, 2002, newborn hearing screening be conducted on no fewer than 95 percent of all newborn infants born in hospitals in this state, using procedures established by rule and regulation of the Board of Public Health after review of any recommendations of the advisory committee on hearing in newborn infants, created in former subsection (d) of this Code section. Toward that end, on and after July 1, 2001, every licensed or certified hospital and physician shall educate the parents of newborn infants born in such hospitals of the importance of screening the hearing of newborn infants and follow-up care. Education shall not be considered a substitute for the hearing screening described in this subsection. Every licensed or permitted hospital shall report annually to the Department of Public Health concerning the following:
   1. The number of newborn infants born in the hospital;
   2. The number of newborn infants screened;
   3. The number of newborn infants who passed the screening, if administered; and
   4. The number of newborn infants who did not pass the screening, if administered.
6. Reserved.
7. Reserved.
8. Reserved.
9. A physician, registered professional nurse, including a certified nurse midwife, or other health professional attending a birth outside a hospital or institution shall provide information, as established by the department, to parents regarding places where the parents may have their infants' screening and the importance of such screening.
10. The department shall encourage the cooperation of local health departments, health care clinics, school districts, health care providers, and any other appropriate resources to promote the screening of newborn infants' hearing and early identification and intervention for those determined to have hearing loss for those infants born outside a hospital or institution. (Code 1981, § 31-1-3.2 , enacted by Ga. L. 1999, p. 266, § 1; Ga. L. 2009, p. 453, §§ 1-4, 1-5/HB 228; Ga. L. 2011, p. 705, §§ 6-3, 6-4/HB 214; Ga. L. 2012, p. 775, § 31/HB 942.)

Cross references. - Hearing handicap, T. 30, C. 1.

Rights of persons with visual disabilities and deaf persons, T. 30, C. 4.

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2000, in subsection (e), ", 2001" was substituted for "of the first year following the year this Code section first becomes effective" and ", 2002" was substituted for "of the second year following the year this Code section first becomes effective".

Pursuant to Code Section 28-9-5, in 2009, "former" was inserted preceding "subsection (d)" in subsection (e).

Editor's notes. - Ga. L. 1999, p. 266, § 1 provided for the repeal of former subsection (d), effective July 1, 2005.

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-1-4. Penalties for false representation, impersonation.

1. Any person who shall make, utter, execute, or submit to the department or to any county board of health any oral or written representation, knowing the same to be false, for the purpose of obtaining anything of value, including any service, shall be guilty of a misdemeanor.
2. Any person who shall impersonate or otherwise falsely hold himself out to any other person as an agent of the department or of any county board of health shall be guilty of a misdemeanor.

   (Ga. L. 1950, p. 222, §§ 1, 2; Code 1933, §§ 88-9901, 88-9902, enacted by Ga. L. 1964, p. 499, § 1.)

Cross references. - Impersonating public officers or employees generally, § 16-10-23 .

31-1-5. Compensation of employees for damage to wearing apparel caused by patients.

1. As used in this Code section, the term "wearing apparel" includes eyeglasses, hearing aids, clothing, and similar items worn on the person of the employee.
2. When action by a patient in one of the institutions operated by the department results in damage to an item of wearing apparel of an employee of the institution, the department shall compensate the employee for the loss in the amount of either the repair cost or the replacement value or the cost of the item of wearing apparel, whichever is less. Such losses shall be compensated only in accordance with procedures to be established by the department, and no compensation shall be made by the department in excess of $500.00 per claim.

   (Code 1933, § 88-2411, enacted by Ga. L. 1981, p. 854, § 1.)

31-1-6. Reuse of heart pacemakers.

1. As used in this Code section, the term:
   1. "Heart pacemaker" means any electrical device which stimulates the heart muscle so that it contracts at a certain or regular rate.
   2. "Medically acceptable" means conforming to prevailing medical standards of cleanliness and manufacturers' applicable standards for functional operation.
   3. "Person" includes the following:
      1. Any hospital, surgeon, or physician;
      2. Any accredited medical school, college, or university;
      3. Any licensed, accredited, or approved bank or storage facility of human bodies or parts; or
      4. Any specified individual needing implantation of a heart pacemaker.
2. Any person, as defined in subsection (a) of this Code section, shall be authorized to receive and reuse a heart pacemaker, provided that such device is medically acceptable for its proposed reuse.
3. This Code section shall not apply to the receipt and reuse of a nuclear-powered pacemaker. (Code 1981, § 31-1-6 , enacted by Ga. L. 1984, p. 1034, § 1.)

Cross references. - Anatomical gifts, § 44-5-140 et seq.

Disposition of heart pacemakers, § 53-4-73 .

31-1-7. Marking of dentures and other removable dental prostheses for identification.

1. Every complete upper and lower denture and removable permanent partial denture fabricated by a dentist licensed in Georgia shall be marked with the name or social security number of the patient for whom it is intended. The marking shall be done during fabrication and shall be permanent, legible, and cosmetically acceptable. The exact location of the marking and the methods used to apply or implant it shall be determined by the dentist.
2. If, in the professional judgment of the dentist, this marking is not practicable, the marking shall be as follows:
   1. The initials of the patient may be shown if the use of the full name or social security number is impossible; or
   2. The marking may be omitted entirely if none of the markings so specified are practical or clinically safe.
3. Any removable dental prosthesis in existence prior to July 1, 1988, shall be marked in accordance with this Code section at the time of any subsequent rebasing.
4. It shall be the duty of the Georgia Board of Dentistry to notify each person licensed to practice dentistry in this state of the requirements of this Code section.  Such notification shall be mailed to the address of record of each person licensed to practice dentistry in this state. (Code 1981, § 31-1-7 , enacted by Ga. L. 1988, p. 742, § 1; Ga. L. 1991, p. 600, §§ 1, 2.)

31-1-8. Notice of proposed special facility.

1. For the purposes of this Code section, the term "special facility" means any of the following facilities:
   1. A facility utilized for the diagnosis, care, treatment, or hospitalization of persons who are alcoholics, drug dependent individuals, or drug users as defined in paragraph (11) of Code Section 37-7-1; or
   2. A facility operated by the Department of Human Services and used for the treatment and residence of delinquent children, provided such facility affords secure custody.
2. At least 30 days prior to the expenditure of state funds for any new or additional special facility by the Department of Behavioral Health and Developmental Disabilities or the Department of Human Services or an agency or board of health contracting with the Department of Behavioral Health and Developmental Disabilities or the Department of Human Services, such department or such agency or board shall notify the governing authority of the county and any municipality wherein the special facility is to be located and each member of the General Assembly whose Senate or House district includes any part of the property upon which the facility is to be located.  Such notification shall include a description of the proposed special facility, including its proposed location, the category of patients or persons to be confined therein, and the maximum number of patients or persons to be so confined.  The Department of Behavioral Health and Developmental Disabilities or the Department of Human Services shall include such requirements in all departmental contracts entered into with such boards or agencies. (Code 1981, § 31-1-8 , enacted by Ga. L. 1992, p. 2120, § 1.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2009, in paragraph (a)(2), "Department of Human Services" was substituted for "department", and, in subsection (b), "Department of Behavioral Health and Developmental Disabilities or the Department of Human Services" was substituted for "Department of Human Resources" three times, and "such department" was substituted for "the department" in the first sentence.

31-1-9. Breast-feeding of baby.

The breast-feeding of a baby is an important and basic act of nurture which should be encouraged in the interests of maternal and child health. A mother may breast-feed her baby in any location where the mother and baby are otherwise authorized to be.

(Code 1981, § 31-1-9 , enacted by Ga. L. 1999, p. 464, § 1; Ga. L. 2002, p. 1139, § 1.)

Cross references. - Newborn Baby and Mother Protection Act, § 33-24-58 .

Employer obligation to provide time for women to express breast milk for infant child, § 34-1-6 .

Law reviews. - For note on the 2002 amendment of this Code section, see 19 Ga. St. U. L. Rev. 209 (2002).

31-1-10. State health officer; duties.

1. The position of state health officer is created. The Governor may appoint the commissioner of public health to serve simultaneously as the state health officer or may appoint another individual to serve as state health officer. Such officer shall serve at the pleasure of the Governor. An individual appointed to serve as state health officer shall be licensed to practice medicine in this state.
2. The state health officer shall:
   1. Perform such health emergency preparedness and response duties as assigned by the Governor; and
   2. Be authorized to issue a standing order prescribing an opioid antagonist, as such term is defined in Code Section 26-4-116.2 , on a state-wide basis under conditions that he or she determines to be in the best interest of this state. (Code 1981, § 31-1-10 , enacted by Ga. L. 2009, p. 453, § 1-3/HB 228; Ga. L. 2011, p. 705, § 3-6/HB 214; Ga. L. 2017, p. 22, § 5/SB 121; Ga. L. 2017, p. 319, § 3-2/HB 249.)

The 2017 amendments. The first 2017 amendment, effective May 18, 2017, added the fourth sentence of subsection (a), and substituted the present provisions of subsection (b) for the former provisions, which read: "The state health officer shall perform such health emergency preparedness and response duties as assigned by the Governor." The second 2017 amendment, effective July 1, 2017, made identical changes.

Editor's notes. - Ga. L. 2017, p. 22, § 1/SB 121, not codified by the General Assembly, provides that: "This Act shall be known and may be cited as the 'Jeffrey Dallas Gay, Jr., Act.'"

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011). For article on the 2017 amendment of this Code section, see 34 Ga. St. U. L. Rev. 143 (2017).

31-1-11. No legal compulsion to participate in health care system; no legal prohibition on purchase or sale of health insurance in private health care systems.

1. As used in this Code section, the term:
   1. "Compel" includes penalties or fines.
   2. "Direct payment" or "pay directly" means payment for lawful health care services without a public or private third party, not including an employer, paying for any portion of the service.
   3. "Health care system"' means any public or private entity whose function or purpose is the management of, processing of, enrollment of individuals for, or payment for, in full or in part, health care services or health care data or health care information for its participants.
   4. "Lawful health care services" means any health related service or treatment to the extent that the service or treatment is permitted or not prohibited by law or regulation that may be provided by persons or businesses otherwise permitted to offer such services.
   5. "Penalties or fines" means any civil or criminal penalty or fine, tax, salary or wage withholding or surcharge, or any named fee with a similar effect established by law or rule by a government established, created, or controlled agency that is used to punish or discourage the exercise of rights protected under this Code section.
2. To preserve the freedom of citizens of this state to provide for their health care:
   1. No law or rule or regulation shall compel, directly or indirectly, any person, employer, or health care provider to participate in any health care system; and
   2. A person or employer may pay directly for lawful health care services and shall not be required to pay penalties or fines for paying directly for lawful health care services. A health care provider may accept direct payment for lawful health care services and shall not be required to pay penalties or fines for accepting direct payment from a person or employer for lawful health care services.
3. Subject to reasonable and necessary rules and regulations that do not substantially limit a person's options, the purchase or sale of health insurance in private health care systems shall not be prohibited by law or by rule or regulation.
4. This Code section shall not:
   1. Affect which health care services a health care provider or hospital is required to perform or provide;
   2. Affect which health care services are permitted by law;
   3. Prohibit care provided pursuant to any statutes enacted by the General Assembly relating to workers' compensation;
   4. Prohibit the imposition by the General Assembly of conditions and limitations on the use or applicability of exemptions and deductions with regard to income taxation;
   5. Affect laws or rules in effect as of January 1, 2009; or
   6. Affect the terms or conditions of any health care system to the extent that those terms and conditions do not have the effect of punishing a person or employer for paying directly for lawful health care services or a health care provider or hospital for accepting direct payment from a person or employer for lawful health care services. (Code 1981, § 31-1-11 , enacted by Ga. L. 2010, p. 755, § 1/SB 411.)

31-1-12. Hospitals to provide educational information to parents of newborns regarding pertussis disease and availability of a vaccine.

1. During the postpartum period and prior to discharge, each hospital shall provide parents of newborns educational information on pertussis disease and the availability of a vaccine to protect against such disease. Such educational information shall include, but not be limited to, information on the recommendation by the federal Centers for Disease Control and Prevention that parents of newborns receive the vaccination during the postpartum period to protect the newborns from the transmission of pertussis.
2. Nothing in this Code section shall be construed to require any hospital to provide or pay for any vaccination against pertussis. (Code 1981, § 31-1-12 , enacted by Ga. L. 2011, p. 704, § 1/HB 249.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2011, Code Section 31-1-12, as enacted by Ga. L. 2011, p. 705, § 2-1, was redesignated as Code Section 31-1-13.

Law reviews. - For article on the 2011 enactment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011). For article, "Health: Department of Public Health," see 28 Ga. St. U. L. Rev. 147 (2011).

31-1-13. Hemophilia Advisory Board.

1. The commissioner of public health in conjunction with the commissioner of community health shall establish an independent advisory board known as the Hemophilia Advisory Board.
2. 1. The following persons shall serve as nonvoting members of the Hemophilia Advisory Board:
      1. The commissioner of public health or a designee; and
      2. The commissioner of community health or a designee.
   2. The following voting members shall be appointed by the commissioner of public health, in consultation with the commissioner of community health, and shall serve a three-year term:
      1. One member who is a board certified physician licensed, practicing, and currently treating individuals with hemophilia and other bleeding disorders and who specializes in the treatment of these individuals;
      2. One member who is a nurse licensed, practicing, and currently treating individuals with hemophilia and other bleeding disorders;
      3. One member who is a social worker licensed, practicing, and currently treating individuals with hemophilia and other bleeding disorders;
      4. One member who is a representative of a federally funded hemophilia treatment center in this state;
      5. One member who is a representative of a nonprofit organization that has, as its primary purpose, the provision of services to the population of this state with hemophilia and other bleeding disorders;
      6. One member who is a person who has hemophilia;
      7. One member who is a caregiver of a person who has hemophilia; and
      8. One member who is a person who has a bleeding disorder other than hemophilia or who is a caregiver of a person who has a bleeding disorder other than hemophilia.
   3. The Hemophilia Advisory Board may also have up to five additional nonvoting members as determined appropriate by the commissioner and the commissioner of community health. These nonvoting members may be persons with, or caregivers of a person with, hemophilia or other bleeding disorder or persons experienced in the diagnosis, treatment, care, and support of individuals with hemophilia or other bleeding disorders.
3. 1. Board members shall elect from among the voting board members a presiding officer. The presiding officer retains all voting rights.
   2. A majority of the members shall constitute a quorum at any meeting held by the Hemophilia Advisory Board.
   3. If there is a vacancy on the Hemophilia Advisory Board, such position shall be filled in the same manner as the original appointment.
   4. Members of the Hemophilia Advisory Board shall receive no compensation for service on the Hemophilia Advisory Board.
4. The Hemophilia Advisory Board shall meet at least quarterly and at the call of the commissioner, the commissioner of community health, or the presiding officer and follow all policies and procedures of Chapter 14 of Title 50, relating to open and public meetings.
5. The department shall provide reasonably necessary administrative support for Hemophilia Advisory Board activities.
6. The Hemophilia Advisory Board shall review and make recommendations to the commissioner and the commissioner of community health with regard to issues that affect the health and wellness of persons living with hemophilia and other bleeding disorders, including, but not limited to, the following:
   1. Proposed legislative or administrative changes to policies and programs that are integral to the health and wellness of individuals with hemophilia and other bleeding disorders;
   2. Standards of care and treatment for persons living with hemophilia and other bleeding disorders, taking into consideration the federal and state standards of care guidelines developed by state and national organizations, including, but not limited to, the Medical and Scientific Advisory Council of the National Hemophilia Foundation;
   3. The development of community based initiatives to increase awareness of care and treatment for persons living with hemophilia and other bleeding disorders; and
   4. The coordination of public and private support networking systems.
7. The Hemophilia Advisory Board shall, no later than October 1, 2019, and annually thereafter, submit to the Office of Health Strategy and Coordination a report of its findings and recommendations. Annually thereafter, the commissioner of public health, in consultation with the commissioner of community health, shall report to the Governor and the General Assembly on the status of implementing the recommendations as proposed by the Hemophilia Advisory Board. The reports shall be made public and shall be subject to public review and comment. (Code 1981, § 31-1-13 , enacted by Ga. L. 2011, p. 705, § 2-1/HB 214; Ga. L. 2019, p. 148, § 2-3/HB 186.)

The 2019 amendment, effective July 1, 2019, substituted "October 1, 2019, and annually thereafter, submit to the Office of Health Strategy and Coordination" for "January, 2012, and annually thereafter, submit to the Governor and the General Assembly" in the first sentence of subsection (g).

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2011, Code Section 31-1-12, as enacted by Ga. L. 2011, p. 705, § 2-1, was redesignated as Code Section 31-1-13.

Pursuant to Code Section 28-9-5, in 2011, "January 1, 2012" was substituted for "six months after the effective date of this Code section" in subsection (g).

Editor's notes. - Ga. L. 2011, p. 705, § 1-1/HB 214, not codified by the General Assembly, provides that: "Parts I and II of this Act shall be known and may be cited as the 'Hemophilia Advisory Board Act.'"

Ga. L. 2011, p. 705, § 1-2/HB 214, not codified by the General Assembly, provides that: "The General Assembly finds that hemophilia and other bleeding disorders are devastating health conditions that can cause serious financial, social, and emotional hardships for patients and their families. Hemophilia and other bleeding disorders are incurable, so appropriate lifetime care and treatment are necessities for maintaining optimum health. Advancements in drug therapies are allowing individuals greater latitude in managing their conditions, fostering independence, and minimizing chronic complications. As a result, individuals are living longer and are healthier and more productive. However, the rarity of these disorders coupled with the delicate processes of producing clotting factor concentrates makes treating these disorders extremely costly. It is the intent of the General Assembly to establish an advisory board to provide expert advice to the state on health and insurance policies, plans, and programs that impact individuals with hemophilia and other bleeding disorders."

Ga. L. 2019, p. 148, § 2-1/HB 186, not codified by the General Assembly, provides: "This part shall be known and may be cited as 'The Health Act.'"

Law reviews. - For article on Crimes and Offenses: Crimes Against the Person, see 35 Ga. St. U. L. Rev. 19 (2018).

31-1-14. Physician Orders for Life-Sustaining Treatment (POLST) forms.

1. As used in this Code section, the term:
   1. "Attending physician" means the physician who has primary responsibility at the time of reference for the treatment and care of the patient.
   2. "Authorized person" shall have the same meaning as in Code Section 31-39-2.
   3. "Decision-making capacity" means the ability to understand and appreciate the nature and consequences of an order regarding end of life care decisions, including the benefits and disadvantages of such an order, and to reach an informed decision regarding the order.
   4. "Health care facility" shall have the same meaning as in Code Section 31-32-2.
   5. "Health care provider" shall have the same meaning as in Code Section 31-32-2.
   6. "Life-sustaining procedures" means medications, machines, or other medical procedures or interventions which, when applied to a patient in a terminal condition or in a state of permanent unconsciousness, could in reasonable medical judgment keep the patient alive but cannot cure the patient and where, in the judgment of the attending physician and a second physician, death will occur without such procedures or interventions. The term "life-sustaining procedures" shall not include the provision of nourishment or hydration, but a patient may direct the withholding or withdrawal of the provision of nourishment or hydration in a POLST form. The term "life-sustaining procedures" shall not include the administration of medication to alleviate pain or the performance of any medical procedure deemed necessary to alleviate pain.
   7. "Physician Orders for Life-Sustaining Treatment form" or "POLST form" means a form executed pursuant to this Code section which provides directions regarding the patient's end of life care.
   8. "Provision of nourishment or hydration" means the provision of nutrition or fluids by tube or other medical means.
   9. "State of permanent unconsciousness" means an incurable or irreversible condition in which the patient is not aware of himself or herself or his or her environment and in which the patient is showing no behavioral response to his or her environment.
   10. "Terminal condition" means an incurable or irreversible condition which would result in the patient's death in a relatively short period of time.
2. The department shall develop and make available a Physician Orders for Life-Sustaining Treatment form. On and after July 1, 2016, the department shall notify the chairpersons and each member of the House Committee on Health and Human Services and the Senate Health and Human Services Committee at least 60 days prior to implementing any modification of the POLST form. Such form shall provide directions regarding the patient's end of life care and may be voluntarily executed by either a patient who has decision-making capacity and an attending physician or, if the patient does not have decision-making capacity, by the patient's authorized person and an attending physician; provided, however, that this shall not prevent a health care facility from imposing additional administrative or procedural requirements regarding a patient's end of life care decisions. A POLST form may be executed when a patient has a serious illness or condition and the attending physician's reasoned judgment is that the patient will die within the next 365 days; provided, however, that a POLST form may be executed at any time if a person has been diagnosed with dementia or another progressive, degenerative disease or condition that attacks the brain and results in impaired memory, thinking, and behavior. A POLST form, if signed by an authorized person, shall indicate the relationship of the authorized person to the patient pursuant to paragraph (3) of Code Section 31-39-2.
3. 1. A POLST form shall constitute a legally sufficient order that may be utilized by a health care provider or health care facility in accordance with its policies and procedures regarding end of life care. Such an order shall remain effective unless the order is revoked by the attending physician upon the consent of the patient or the patient's authorized person. An attending physician who has issued such an order and who transfers care of the patient to another physician shall inform the receiving physician and the health care facility, if applicable, of the order. Review of the POLST form is recommended at care transitions, and such review should be specified on the form.
   2. A POLST form signed by the patient and attending physician and indicating "allow natural death" or "do not resuscitate" or the equivalent may be implemented without restriction. If the POLST form (i) is signed by the attending physician and an authorized person instead of the patient and (ii) indicates "allow natural death" or "do not resuscitate" or the equivalent, in compliance with subsection (c) of Code Section 31-39-4, the POLST form may be implemented or become effective when the patient is a candidate for nonresuscitation, and such consent shall be based in good faith upon what such authorized person determines such candidate for nonresuscitation would have wanted had such candidate for nonresuscitation understood the circumstances under which such order is being considered.
   3. A POLST form addressing interventions other than resuscitation and signed by the patient and attending physician may be implemented without restriction. If the POLST form is signed by an authorized person who is the health care agent named by the patient in an advance directive for health care and the attending physician, in compliance with paragraph (1) of subsection (e) of Code Section 31-32-7, all treatment indications on the POLST form may be implemented. If the POLST form is signed by an authorized person who is not the health care agent named by the patient in an advance directive for health care, treatment indications on the POLST form may be implemented or become effective only when the patient is in a terminal condition or a state of permanent unconsciousness; provided, however, that a POLST form may become effective at any time if a person has been diagnosed with dementia or another progressive, degenerative disease or condition that attacks the brain and results in impaired memory, thinking, and behavior.
   4. A POLST form shall be portable with the patient across care settings and shall be valid in any health care facility in which the patient who is the subject of such form is being treated; provided, however, that this shall not prevent a health care facility from imposing additional requirements regarding a patient's end of life care decisions. A health care facility and a health care provider, in its discretion, may rely upon a POLST form as legally valid consent by the patient to the terms therein.
   5. A copy of a POLST form shall be valid and have the same meaning and effect as the original document.
   6. A physician orders for life-sustaining treatment form which was executed in another state, which is valid under the laws of such state and which is substantially similar to the Georgia POLST form, and contains signatures of (i) either the patient or an authorized person and (ii) the attending physician, shall be treated as a POLST form which complies with this Code section.
4. 1. Each health care provider, health care facility, and any other person who acts in good faith reliance on a POLST form shall be protected and released to the same extent as though such provider, facility, or other person had interacted directly with the patient as a fully competent person. Without limiting the generality of the foregoing, the following specific provisions shall also govern, protect, and validate the acts of an authorized person and each such health care provider, health care facility, and any other person acting in good faith reliance on such POLST form:
      1. No such health care provider, health care facility, or person shall be subject to civil or criminal liability or discipline for unprofessional conduct solely for complying with a patient's end of life care decisions as provided in a POLST form, even if death or injury to the patient ensues;
      2. No such health care provider, health care facility, or person shall be subject to civil or criminal liability or discipline for unprofessional conduct solely for failure to comply with a patient's end of life care decisions in a POLST form, so long as such health care provider, health care facility, or person promptly informs the patient or the patient's authorized person of such health care provider's, health care facility's, or person's refusal or failure to comply with such patient's end of life care decisions in a POLST form. The authorized person shall then be responsible for arranging the patient's transfer to another health care provider or health care facility. A health care provider, health care facility, or person who is unwilling to comply with a patient's end of life care decisions in a POLST form shall continue to provide reasonably necessary consultation and care in connection with the pending transfer;
      3. If the actions of a health care provider, health care facility, or person who fails to comply with a patient's end of life care decisions in a POLST form are substantially in accord with reasonable medical standards at the time of reference and such provider, facility, or person cooperates in the transfer of the patient, then the health care provider, health care facility, or person shall not be subject to civil or criminal liability or discipline for unprofessional conduct for failure to comply with such patient's end of life care decisions in a POLST form;
      4. No authorized person who, in good faith, acts with due care for the benefit of the patient and in accordance with a patient's end of life care decisions in a POLST form, or who fails to act, shall be subject to civil or criminal liability for such action or inaction; and
      5. If a POLST form is revoked, a person shall not be subject to criminal prosecution or civil liability for acting in good faith reliance upon a patient's end of life care decisions in a POLST form unless such person had actual knowledge of the revocation.
   2. No person shall be civilly liable for failing or refusing in good faith to effectuate a patient's end of life care decisions in a POLST form regarding the withholding or withdrawal of life-sustaining procedures or the withholding or withdrawal of the provision of nourishment or hydration.
   3. No physician or any person acting under a physician's direction and no health care facility or any agent or employee thereof who, acting in good faith in accordance with the requirements of this Code section, causes the withholding or withdrawal of life-sustaining procedures or the withholding or withdrawal of the provision of nourishment or hydration from a patient or who otherwise participates in good faith therein shall be subject to any civil or criminal liability or guilty of unprofessional conduct therefor.
   4. Any person who participates in the withholding or withdrawal of life-sustaining procedures or the withholding or withdrawal of the provision of nourishment or hydration pursuant to a patient's end of life care decisions in a POLST form and who has actual knowledge that such POLST form has been properly revoked shall not have any civil or criminal immunity otherwise granted under this subsection for such conduct.
5. In the event there are any directions in a patient's previously executed living will, advance directive for health care, durable power of attorney for health care, do not resuscitate order, or other legally authorized instrument that conflict with the directions in a POLST form, the most recent instrument will take precedence to the extent of the conflict.
6. Nothing in this Code section shall be construed to authorize any act prohibited by Code Section 16-5-5 . Any health care provider, health care facility, or any other person who violates Code Section 16-5-5 shall not be entitled to any civil immunity provided pursuant to this Code section. (Code 1981, § 31-1-14 , enacted by Ga. L. 2015, p. 305, § 1/SB 109; Ga. L. 2016, p. 757, § 1/SB 305; Ga. L. 2016, p. 864, § 31/HB 737.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2015, Code Section 31-1-14, as enacted by Ga. L. 2015, p. 312, § 2/SB 126, was redesignated as Code Section 31-1-15.

Law reviews. - For annual survey on wills, trusts, guardianships, and fiduciary administration, see 67 Mercer L. Rev. 273 (2015).

31-1-15. Storage, maintenance, control, and oversight of auto-injectable epinephrine by certain authorized entities.

1. As used in this Code section, the term:
   1. "Authorized entity" means any entity or organization, other than a school subject to Code Section 20-2-776.2, in connection with or at which allergens capable of causing anaphylaxis may be present, as identified by the department. The department shall, through rule or other guidance, identify the types of entities and organizations that are considered authorized entities no later than January 1, 2016, and shall review and update such rule or guidance at least annually thereafter. For purposes of illustration only, such entities may include, but are not limited to, restaurants, recreation camps, youth sports leagues, theme parks and resorts, and sports arenas.
   2. "Auto-injectable epinephrine" means a single-use device used for the automatic injection of a premeasured dose of epinephrine into the human body.
   3. "Health care practitioner" means a physician licensed to practice medicine in this state, an advanced practice registered nurse acting pursuant to the authority of Code Section 43-34-25, and a physician assistant acting pursuant to the authority of subsection (e.1) of Code Section 43-34-103.
2. An authorized entity may acquire and stock a supply of auto-injectable epinephrine pursuant to a prescription issued in accordance with Code Section 26-4-116.1. Such auto-injectable epinephrine shall be stored in a location readily accessible in an emergency and in accordance with the auto-injectable epinephrine's instructions for use and any additional requirements that may be established by the department. An authorized entity shall designate employees or agents who have completed the training required by subsection (d) of this Code section to be responsible for the storage, maintenance, control, and general oversight of auto-injectable epinephrine acquired by the authorized entity.
3. An employee or agent of an authorized entity, or any other individual, who has completed the training required by subsection (d) of this Code section may use auto-injectable epinephrine prescribed pursuant to Code Section 26-4-116.1 to:
   1. Provide auto-injectable epinephrine to any individual who the employee, agent, or other individual believes in good faith is experiencing anaphylaxis, or to the parent, guardian, or caregiver of such individual, for immediate administration, regardless of whether the individual has a prescription for auto-injectable epinephrine or has previously been diagnosed with an allergy; and
   2. Administer auto-injectable epinephrine to any individual who the employee, agent, or other individual believes in good faith is experiencing anaphylaxis, regardless of whether the individual has a prescription for auto-injectable epinephrine or has previously been diagnosed with an allergy.
4. An employee, agent, or other individual described in subsection (b) or (c) of this Code section shall complete an anaphylaxis training program and repeat such training at least every two years following completion of the initial anaphylaxis training program. Such training shall be conducted by a nationally recognized organization experienced in training laypersons in emergency health treatment or an entity or individual approved by the department. Training may be conducted online or in person and, at a minimum, shall cover:
   1. How to recognize signs and symptoms of severe allergic reactions, including anaphylaxis;
   2. Standards and procedures for the storage and administration of auto-injectable epinephrine; and
   3. Emergency follow-up procedures.
5. An authorized entity that possesses and makes available auto-injectable epinephrine and its employees, agents, and other individuals; a health care practitioner that prescribes or dispenses auto-injectable epinephrine to an authorized entity; a pharmacist or health care practitioner that dispenses auto-injectable epinephrine to an authorized entity; and an individual or entity that conducts the training described in subsection (d) of this Code section shall not be liable for any injuries or related damages that result from any act or omission taken pursuant to this Code section; provided, however, that this immunity does not apply to acts or omissions constituting willful or wanton misconduct. The administration of auto-injectable epinephrine in accordance with this Code section is not the practice of medicine or any other profession that otherwise requires licensure. This Code section does not eliminate, limit, or reduce any other immunity or defense that may be available under state law, including that provided under Code Section 51-1-29. An entity located in this state shall not be liable for any injuries or related damages that result from the provision or administration of auto-injectable epinephrine outside of this state if the entity:
   1. Would not have been liable for such injuries or related damages had the provision or administration occurred within this state; or
   2. Is not liable for such injuries or related damages under the law of the state in which such provision or administration occurred.
6. An authorized entity that possesses and makes available auto-injectable epinephrine shall submit to the department, on a form developed by the department, a report including each incident on the authorized entity's premises that involves the administration of auto-injectable epinephrine pursuant to subsection (c) of this Code section and any other information deemed relevant by the department. The department shall annually publish a report that summarizes and analyzes all reports submitted to it under this subsection.
7. The department shall establish requirements regarding the storage, maintenance, control, and oversight of the auto-injectable epinephrine, including but not limited to any temperature limitations and expiration of such auto-injectable epinephrine. (Code 1981, § 31-1-15 , enacted by Ga. L. 2015, p. 312, § 2/SB 126.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2015, Code Section 31-1-14, as enacted by Ga. L. 2015, p. 312, § 2/SB 126, was redesignated as Code Section 31-1-15.

31-1-16. Reporting information concerning nurses holding multistate licenses.

The Board of Community Health shall require health care providers and entities that employ one or more nurses holding a multistate license pursuant to Article 4 of Chapter 26 of Title 43 for 30 days or more in a calendar year to report to such board the name, address, and duration of employment of each such nurse in a form and pursuant to a schedule established by such board. The Board of Community Health shall provide such information to the Georgia Board of Nursing.

(Code 1981, § 31-1-16 , enacted by Ga. L. 2019, p. 219, § 7/SB 168.)

Effective date. - This Code section became effective April 25, 2019.

31-1-17. Notification of dense breast tissue.

1. As used in this Code section, the term:
   1. "Dense breast tissue" means heterogeneously or extremely dense breast tissue based on nationally recognized guidelines or systems for breast imaging reporting of mammography including, but not limited to, the Breast Imaging Reporting and Data System established by the American College of Radiology.
   2. "Health care facility" means a hospital, outpatient department, clinic, radiology practice, or mobile unit; an office of a physician; or other medical facility.
2. If a patient's mammogram demonstrates dense breast tissue, the health care facility that conducted the mammogram shall provide notification to the patient that includes, but is not limited to, the following information, in the summary of the results of a mammography examination that is sent directly to a patient pursuant to 42 U.S.C. Section 263b: "Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However, dense breast tissue can make it more difficult to detect cancer through a mammogram. Also, dense breast tissue may increase your risk for breast cancer. This information about the result of your mammogram is given to you to increase your awareness. Use this information to talk with your health care provider about whether other supplemental tests in addition to your mammogram may be appropriate for you, based on your individual risk. A report of your results was sent to your ordering physician. If you are self-referred, a report of your results was sent to you in addition to this summary." (Code 1981, § 31-1-17 , enacted by Ga. L. 2019, p. 336, § 2/HB 62.)

Effective date. - This Code section became effective July 1, 2019.

Cross references. - Breast cancer patient care, § 33-24-70 et seq.

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2019, this Code Section enacted as Code Section 31-1-16 was redesignated as Code Section 31-1-17.

Editor's notes. - Ga. L. 2019, p. 336, § 1/HB 62, not codified by the General Assembly, provides: "This Act shall be known and may be cited as 'Margie's Law.'"

U.S. Code. - Section 263b of 42 U.S.C., referred to in subsection (b), concerns the certification of mammography facilities.

31-1-20 through 31-1-22.

Reserved. Repealed by Ga. L. 2005, p. 692, § 1/SB 81, effective July 1, 2005.

Editor's notes. - These Code sections were based on Ga. L. 1997, p. 1585, § 3; Ga. L. 1998, p. 128, § 31.

31-1-23. Blindness education, screening, and treatment program.

1. 1. Subject to availability of funds voluntarily donated and transmitted to the department for such purposes pursuant to subsection (e) of Code Section 40-5-25, the department shall develop a blindness education, screening, and treatment program to provide blindness prevention education and to provide screening and treatment for residents who do not have adequate coverage for such services under a health benefit plan.
   2. Funds voluntarily donated and transmitted to the department pursuant to subsection (e) of Code Section 40-5-25 shall be expended only for purposes of the program provided by this Code section.
2. The program shall provide for:
   1. Public education about blindness and other eye conditions;
   2. Screenings and eye examinations to identify conditions that may cause blindness; and
   3. Treatment procedures necessary to prevent blindness.
3. The department may contract for program development with any department approved nonprofit organization dealing with regional and community blindness education, eye donor, and vision treatment services.
4. The department by regulation shall prescribe eligibility requirements for the program. (Code 1981, § 31-1-23 , enacted by Ga. L. 1999, p. 537, § 1.)

Cross references. - Funds for operation of schools for deaf and blind persons, § 20-2-302 .

Georgia Industries for the Blind, T. 30, C. 2.

Aid to the blind, § 49-4-50 et seq.

31-1-18. (Effective January 1, 2021) Individuals with high risk for breast cancer; consumer information.

1. As used in this Code section, the term "individual with a high risk for breast cancer" means an individual:
   1. With a lifetime risk of breast cancer of 20 percent or greater as according to a risk assessment tool based primarily on family history, such as but not limited to, the Tyrer-Cuzick Version 8.0b model;
   2. With a known BRCA1 or BRCA2 gene mutation based on genetic testing;
   3. Who has not had genetic testing, but has a first-degree relative with a BRCA1 or BRCA2 gene mutation;
   4. Who has had radiation therapy to the chest between ten and 30 years of age; and
   5. Who has Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome or has a first-degree relative who has any such syndrome.
2. The department, in consultation with the Georgia Composite Medical Board, shall identify and compile information on factors and pertinent history to identify individuals with a high risk for breast cancer. Such information shall be reviewed annually and updated, if necessary.
3. The information identified and compiled pursuant to subsection (b) of this Code section shall be posted in a prominent location on the department's website for the purpose of providing consumers with information on pertinent family history and other factors that should be provided to an individual's physician to determine whether someone is an individual with a high risk for breast cancer. Such information shall also be annually distributed by the Georgia Composite Medical Board to all physicians licensed to practice medicine in this state. (Code 1981, § 31-1-18 , enacted by Ga. L. 2020, p. 796, § 2/HB 1125.)

Effective date. - This Code section becomes effective January 1, 2021.

Cross references. - Breast cancer screening coverage for individuals with high risk of breast cancer, § 48-18-4.1.

Editor's notes. - Ga. L. 2020, p. 796, § 1/HB 1125, not codified by the General Assembly, provides that: "This Act shall be known and may be cited as 'Lacee's Law.'"

31-1-40. Prohibition on expenditure or use of state resources to advocate for or intend to influence citizens in support of Medicaid expansion under the federal Affordable Care Act.

1. Neither the state nor any department, agency, bureau, authority, office, or other unit of the state nor any political subdivision of the state shall expend or use moneys, human resources, or assets to advocate or intended to influence the citizens of this state in support of the voluntary expansion by the State of Georgia of eligibility for medical assistance in furtherance of the federal Patient Protection and Affordable Care Act, Public Law 111-148, beyond the eligibility criteria in effect on April 15, 2014, under the provisions of 42 U.S.C. Section 1396a(a)(10)(A)(i)(VIII) of the federal Social Security Act, as amended.
2. The Attorney General shall enforce the provisions of this Code section in accordance with Article V, Section III, Paragraph IV of the Constitution of the State of Georgia.
3. Nothing in this Code section shall be construed to prevent an officer or employee of the State of Georgia or of any department, agency, bureau, authority, office, unit, or political subdivision thereof from advocating or attempting to influence public policy:
   1. As part of such person's official duties;
   2. When acting on personal time without using state resources; or
   3. When providing bona fide educational instruction about the federal Patient Protection and Affordable Care Act of 2010 in institutions of higher learning or otherwise.
4. Nothing in this Code section shall be construed to preclude the state from participating in any Medicaid program. (Code 1981, § 31-1-40 , enacted by Ga. L. 2014, p. 243, § 1-2/HB 943; Ga. L. 2019, p. 1056, § 31/SB 52.)

The 2019 amendment, effective May 12, 2019, part of an Act to revise, modernize, and correct the Code, revised punctuation in subsection (a).

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2014, "April 15, 2014," was substituted for "the effective date of this Code section" near the end of subsection (a).

Pursuant to Code Section 28-9-5, in 2019, "Medicaid" was substituted for "MEDICAID" near the end of subsection (d).

Editor's notes. - Ga. L. 2014, p. 243, § 1-1/HB 943, not codified by the General Assembly, provides: "This Act shall be known and may be cited as the 'Georgia Health Care Freedom Act.' "

Law reviews. - For article, "Georgia Health Care Freedom Act," see 31 Ga. St. U. L. Rev. 113 (2014). For note, "A Compelling Interest? Using Old Conceptions of Public Health Law to Challenge the Affordable Care Act's Contraceptive Mandate," see 31 Ga. St. U. L. Rev. 613 (2015). For note, "Charting the Middle Course: An Argument for Robust But Well-Tailored Health Care Discrimination Protection for the Transgender Community," see 52 Ga. L. Rev. 225 (2017).

31-2-1. Legislative intent; grant of authority.

Given the growing concern and complexities of health issues in this state, it is the intent of the General Assembly to create a Department of Community Health dedicated to health issues. Illustrating, without limiting, the foregoing grant of authority, the department is empowered to:

1. Serve as the lead planning agency for all health issues in the state to remedy the current situation wherein the responsibility for health care policy, purchasing, planning, and regulation is spread among many different agencies and achieve determinations of Medicaid eligibility for inmates to attain services at long-term care facilities when he or she is being considered for parole;
2. Permit the state to maximize its purchasing power and to administer its operations in a manner so as to receive the maximum amount of federal financial participation available in expenditures of the department;
3. Minimize duplication and maximize administrative efficiency in the state's health care systems by removing overlapping functions and streamlining uncoordinated programs;
4. Allow the state to develop a better health care infrastructure that is more responsive to the consumers it serves while improving access to and coverage for health care;
5. Focus more attention and departmental procedures on the issue of wellness, including diet, exercise, and personal responsibility;
6. Enter into or upon public or private property at reasonable times for the purpose of inspecting same to determine the presence of conditions deleterious to health or to determine compliance with applicable laws and rules, regulations, and standards thereunder; and
7. Promulgate and enforce rules and regulations for the licensing of medical facilities wherein abortion procedures under subsections (b) and (c) of Code Section 16-12-141 are to be performed. (Code 1981, § 31-5A-1 , enacted by Ga. L. 1999, p. 296, § 1; Code 1981, § 31-2-1 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228; Ga. L. 2011, p. 705, § 4-1/HB 214; Ga. L. 2018, p. 550, § 3-1/SB 407.)

The 2018 amendment, effective July 1, 2018, added "and achieve determinations of Medicaid eligibility for inmates to attain services at long-term care facilities when he or she is being considered for parole" at the end of paragraph (1).

Editor's notes. - The substance of the former Code section, pertaining to duty, functions, and powers of the former Department of Human Resources is now contained in the introductory language and paragraphs (6) through (18) of the present Code section. The former Code section was based on Code 1933, § 88-108, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1971, p. 669, § 1; Ga. L. 1973, p. 635, § 2; Ga. L. 1979, p. 823, §§ 1, 2, and was repealed by Ga. L. 2009, p. 453, § 1-1/HB 228, effective July 1, 2009.

Law reviews. - For article, "Putting the Community Back into the 'Community Benefit' Standard," see 44 Ga. L. Rev. 375 (2010). For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011). For article on the 2018 amendment of this Code section, see 35 Ga. St. U. L. Rev. 45 (2018).

31-2-2. Definitions.

As used in this chapter, the term:

1. "Board" means the Board of Community Health established under Code Section 31-2-3.
2. "Commissioner" means the commissioner of community health established under Code Section 31-2-6.
3. "Department" means the Department of Community Health established under Code Section 31-2-4.
4. "Predecessor agency or unit" means the Department of Community Health, the Division of Public Health of the Department of Human Resources, and the Office of Regulatory Services of the Department of Human Resources.
5. "State health benefit plan" means the health insurance plan authorized under Article 1 of Chapter 18 of Title 45 and Part 6 of Article 17 of Chapter 2 of Title 20.
6. "State Personnel Board" means the board established under Article IV, Section III of the Constitution. (Code 1981, § 31-5A-2, enacted by Ga. L. 1999, p. 296, § 1; Code 1981, § 31-2-2 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228.)

Editor's notes. - Ga. L. 2009, p. 453, § 1-1/HB 228, effective July 1, 2009, redesignated former Code Section 31-2-2 as present Code Section 31-2-7.

31-2-3. Board of Community Health reconstituted; powers, functions, and duties; terms of board members; vacancies; removal; chairperson; expenses.

1. There is reconstituted the Board of Community Health, as of July 1, 2009, which shall establish the general policy to be followed by the Department of Community Health. The powers, functions, and duties of the Board of Community Health as they existed on June 30, 2009, are transferred to the reconstituted Board of Community Health effective July 1, 2009. The board shall consist of nine members appointed by the Governor and confirmed by the Senate.
2. Board members in office on June 30, 2009, shall serve out the remainder of their respective terms and successors to these board seats shall be appointed in accordance with this Code section. Thereafter, all succeeding appointments shall be for three-year terms from the expiration of the previous term.
3. Vacancies in office shall be filled by appointment by the Governor in the same manner as the appointment to the position on the board which becomes vacant, and the appointment shall be submitted to the Senate for confirmation at the next session of the General Assembly. An appointment to fill a vacancy other than by expiration of a term of office shall be for the balance of the unexpired term.
4. Members of the board may be removed from office under the same conditions for removal from office of members of professional licensing boards provided in Code Section 43-1-17.
5. There shall be a chairperson of the board elected by and from the membership of the board who shall be the presiding officer of the board.
6. The members of the board shall receive a per diem allowance and expenses as shall be set and approved by the Office of Planning and Budget in conformance with rates and allowances set for members of other state boards. (Code 1981, § 31-5A-3, enacted by Ga. L. 1999, p. 296, § 1; Ga. L. 2000, p. 1706, § 19; Code 1981, § 31-2-3 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228.)

Cross references. - Rules and regulations as to sanitary requirements; inspections; unsanitary condition as nuisance, § 43-10-6 .

Creation of Board of Human Services, creation of position of commissioner of human services, and further provisions regarding general functions and powers of Department of Human Services, T. 49, C. 2.

Editor's notes. - Ga. L. 2009, p. 453, § 1-1/HB 228, effective July 1, 2009, redesignated former Code Section 31-2-3 as present Code Section 31-2-8.

31-2-4. Department's powers, duties, functions, and responsibilities; divisions; directors; contracts for health benefits.

1. 1. 1. The Department of Community Health is re-created and established to perform the functions and assume the duties and powers exercised on June 30, 2009, by the Department of Community Health, the Division of Public Health of the Department of Human Resources, and the Office of Regulatory Services of the Department of Human Resources, unless specifically transferred to the Department of Human Services, and such department, division, and office shall be reconstituted as the Department of Community Health effective July 1, 2009. The department shall retain powers and responsibility with respect to the expenditure of any funds appropriated to the department including, without being limited to, funds received by the state pursuant to the settlement of the lawsuit filed by the state against certain tobacco companies, State of Georgia, et al. v. Philip Morris, Inc., et al., Civil Action #E-61692, V19/246 (Fulton County Superior Court, December 9, 1998).
      2. On and after July 1, 2011, the functions, duties, and powers of the Department of Community Health relating to the former Division of Public Health of the Department of Human Resources shall be performed and exercised by the Department of Public Health pursuant to Code Section 31-2A-2. No power, function, responsibility, duty, or similar authority held by the Department of Community Health as of June 30, 2009, shall be diminished or lost due to the creation of the Department of Public Health.
   2. The director of the Division of Public Health in office on June 30, 2009, and the director of the Office of Regulatory Services in office on June 30, 2009, shall become directors of the respective division or office which those predecessor agencies or units have become on and after July 1, 2009, and until such time as the commissioner appoints other directors of such divisions or units. The position of director of the Division of Public Health shall be abolished effective July 1, 2011.
2. Reserved.
3. The Board of Regents of the University System of Georgia is authorized to contract with the department for health benefits for members, employees, and retirees of the board of regents and the dependents of such members, employees, and retirees and for the administration of such health benefits. The department is also authorized to contract with the board of regents for such purposes.
4. In addition to its other powers, duties, and functions, the department:
   1. Shall be the lead agency in coordinating and purchasing health care benefit plans for state and public employees, dependents, and retirees and may also coordinate with the board of regents for the purchase and administration of such health care benefit plans for its members, employees, dependents, and retirees;
   2. Is authorized to plan and coordinate medical education and physician work force issues;
   3. Shall investigate the lack of availability of health insurance coverage and the issues associated with the uninsured population of this state. In particular, the department is authorized to investigate the feasibility of creating and administering insurance programs for small businesses and political subdivisions of the state and to propose cost-effective solutions to reducing the numbers of uninsured in this state;
   4. Is authorized to appoint a health care work force policy advisory committee to oversee and coordinate work force planning activities;
   5. Is authorized to solicit and accept donations, contributions, and gifts and receive, hold, and use grants, devises, and bequests of real, personal, and mixed property on behalf of the state to enable the department to carry out its functions and purposes;
   6. Is authorized to award grants, as funds are available, to hospital authorities, hospitals, and medical-legal partnerships for public health purposes, pursuant to Code Sections 31-7-94 and 31-7-94.1 and paragraph (11) of this subsection;
   7. Shall make provision for meeting the cost of hospital care of persons eligible for public assistance to the extent that federal matching funds are available for such expenditures for hospital care. To accomplish this purpose, the department is authorized to pay from funds appropriated for such purposes the amount required under this paragraph into a trust fund account which shall be available for disbursement for the cost of hospital care of public assistance recipients. The commissioner, subject to the approval of the Office of Planning and Budget, on the basis of the funds appropriated in any year, shall estimate the scope of hospital care available to public assistance recipients and the approximate per capita cost of such care. Monthly payments into the trust fund for hospital care shall be made on behalf of each public assistance recipient and such payments shall be deemed encumbered for assistance payable. Ledger accounts reflecting payments into and out of the hospital care fund shall be maintained for each of the categories of public assistance established under Code Section 49-4-3 . The balance of state funds in such trust fund for the payment of hospital costs in an amount not to exceed the amount of federal funds held in the trust fund by the department available for expenditure under this paragraph shall be deemed encumbered and held in trust for the payment of the costs of hospital care and shall be rebudgeted for this purpose on each quarterly budget required under the laws governing the expenditure of state funds. The state auditor shall audit the funds in the trust fund established under this paragraph in the same manner that any other funds disbursed by the department are audited;
   8. Shall classify and license community living arrangements in accordance with the rules and regulations promulgated by the department for the licensing and enforcement of licensing requirements for persons whose services are financially supported, in whole or in part, by funds authorized through the Department of Behavioral Health and Developmental Disabilities. To be eligible for licensing as a community living arrangement, the residence and services provided must be integrated within the local community. All community living arrangements licensed by the department shall be subject to the provisions of Code Sections 31-2-8 and 31-7-2.2 . No person, business entity, corporation, or association, whether operated for profit or not for profit, may operate a community living arrangement without first obtaining a license or provisional license from the department. A license issued pursuant to this paragraph is not assignable or transferable. As used in this paragraph, the term "community living arrangement" means any residence, whether operated for profit or not, which undertakes through its ownership or management to provide or arrange for the provision of housing, food, one or more personal services, support, care, or treatment exclusively for two or more persons who are not related to the owner or administrator of the residence by blood or marriage;
   9. Shall establish, by rule adopted pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," a schedule of fees for licensure activities for institutions and other health care related entities required to be licensed, permitted, registered, certificated, or commissioned by the department pursuant to Chapter 7, 13, 23, or 44 of this title, Chapter 5 of Title 26, paragraph (8) of this subsection, or Article 7 of Chapter 6 of Title 49. Such schedules shall be determined in a manner so as to help defray the costs incurred by the department, but in no event to exceed such costs, both direct and indirect, in providing such licensure activities. Such fees may be annually adjusted by the department but shall not be increased by more than the annual rate of inflation as measured by the Consumer Price Index, as reported by the Bureau of Labor Statistics of the United States Department of Labor. All fees paid thereunder shall be paid into the general funds of the State of Georgia. It is the intent of the General Assembly that the proceeds from all fees imposed pursuant to this paragraph be used to support and improve the quality of licensing services provided by the department;
   10. 1. May accept the certification or accreditation of an entity or program by a certification or accreditation body, in accordance with specific standards, as evidence of compliance by the entity or program with the substantially equivalent departmental requirements for issuance or renewal of a permit or provisional permit, provided that such certification or accreditation is established prior to the issuance or renewal of such permits. The department may not require an additional departmental inspection of any entity or program whose certification or accreditation has been accepted by the department, except to the extent that such specific standards are less rigorous or less comprehensive than departmental requirements. Nothing in this Code section shall prohibit either departmental inspections for violations of such standards or requirements or the revocation of or refusal to issue or renew permits, as authorized by applicable law, or for violation of any other applicable law or regulation pursuant thereto.
       2. For purposes of this paragraph, the term:
          1. "Entity or program" means an agency, center, facility, institution, community living arrangement, drug abuse treatment and education program, or entity subject to regulation by the department under Chapters 7, 13, 22, 23, and 44 of this title; Chapter 5 of Title 26; paragraph (8) of this subsection; and Article 7 of Chapter 6 of Title 49.
          2. "Permit" means any license, permit, registration, certificate, or commission issued by the department pursuant to the provisions of the law cited in division (i) of this subparagraph;
   11. 1. Is authorized to approve medical-legal partnerships that comply with standards and guidelines established for such programs for purposes of determining eligibility for grants. The department shall seek input from legal services organizations, community health advocacy organizations, hospitals, diagnostic and treatment centers, and other primary and specialty health care providers in establishing such standards and guidelines.
       2. For purposes of this paragraph, the term "medical-legal partnership" means a program conducted or established by a nonprofit entity through a collaboration pursuant to a written agreement between one or more medical service providers and one or more legal services programs, including those based within a law school, to provide legal services without charge to assist income-eligible individuals and their families in resolving legal matters or other needs that have an impact on the health of such individuals and families. Written agreements may include a memorandum of understanding or other agreement relating to the operations of the partnership and encompassing the rights and responsibilities of each party thereto. The medical service provider or providers may provide referrals of its patients to the legal services program or programs on matters that may potentially impact the health, health care, or the health care costs of a patient.
       3. A medical-legal partnership that complies with the standards and guidelines established pursuant to this paragraph and has demonstrated the ability and experience to provide high quality patient centered legal services regarding legal matters or other needs that have an impact on the health of individuals and families shall be approved by the department.
       4. This paragraph shall not be construed to require any medical-legal partnership or similar entity to seek or attain approval pursuant to this paragraph in order to operate;
   12. In cooperation with the Department of Corrections and the State Board of Pardons and Paroles, shall establish and implement a Medicaid eligibility determination procedure so that inmates being considered for parole who are eligible for long-term care services may apply for Medicaid; and
   13. Shall request federal approval for and facilitate the application of certificates of need for facilities capable of providing long-term care services, with Medicaid as the primary funding source, to inmates who are eligible for such services and funding upon his or her release from a public institution, as such term is defined in Code Section 49-4-3 1. (Code 1981, § 31-5A-4, enacted by Ga. L. 1999, p. 296, § 1; Ga. L. 2001, p. 1240, § 1; Ga. L. 2002, p. 1132, § 1; Ga. L. 2002, p. 1324, § 1-4; Code 1981 § 31-2-4 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228; Ga. L. 2009, p. 745, § 2/SB 97; Ga. L. 2010, p. 1014, § 1/HB 994; Ga. L. 2011, p. 705, § 4-2/HB 214; Ga. L. 2014, p. 397, § 1/SB 352; Ga. L. 2018, p. 550, § 3-2/SB 407; Ga. L. 2019, p. 1056, § 31/SB 52; Ga. L. 2020, p. 95, § 2/HB 987.)

The 2018 amendment, effective July 1, 2018, deleted "and" at the end of division (d)(10)(B)(ii), substituted "; and" for the period at the end of subparagraph (d)(11)(D), and added paragraphs (d)(12) and (d)(13).

The 2019 amendment, effective May 12, 2019, part of an Act to revise, modernize, and correct the Code, deleted "and" at the end of subparagraph (d)(11)(D).

The 2020 amendment, effective June 30, 2020, inserted "certificated," in the first sentence of paragraph (d)(9) and inserted "certificate," near the beginning of division (d)(10)(B)(ii).

Cross references. - Georgia Commission on Women, T. 50, C. 12, A. 5.

Code Commission notes. - Ga. L. 2009, p. 745, § 2(14)/SB 97, effective July 1, 2009, purported to substitute "State Personnel Administration" for "State Merit System of Personnel Administration" in former Code Section 31-5A-4, but that amendment was not given effect due to the redesignation and amendment by Ga. L. 2009, p. 453, § 1-1/HB 228, effective July 1, 2009.

Pursuant to Code Section 28-9-5, in 2009, "work force" was substituted for "workforce" in paragraph (d)(2) and "of" was deleted preceding "the amount required" in the second sentence of paragraph (d)(7).

Editor's notes. - Ga. L. 2009, p. 453, § 1-1/HB 228, effective July 1, 2009, redesignated former Code Section 31-2-4 as present Code Section 31-2-9.

Administrative Rules and Regulations. - Hearings and petitions for rule-making, Official Compilation of the Rules and Regulations of the State of Georgia, Department of Human Services, Administration, Chapter 290-1-1.

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011). For article on the 2018 amendment of this Code section, see 35 Ga. St. U. L. Rev. 45 (2018).

31-2-5. Transfer of personnel and functions; conforming to federal standards of personnel administration; existing procedures, regulations, and agreements; rules adoption and implementation.

1. All persons employed in a predecessor agency or unit on June 30, 2009, shall, on July 1, 2009, become employees of the department. Such employees shall be subject to the employment practices and policies of the department on and after July 1, 2009, but the compensation and benefits of such transferred employees shall not be reduced as a result of such transfer. Employees who are subject to the rules of the State Personnel Board and who are transferred to the department shall retain all existing rights under such rules. Retirement rights of such transferred employees existing under the Employees' Retirement System of Georgia or other public retirement systems on June 30, 2009, shall not be impaired or interrupted by the transfer of such employees and membership in any such retirement system shall continue in the same status possessed by the transferred employees on June 30, 2009. Accrued annual and sick leave possessed by said employees on June 30, 2009, shall be retained by said employees as employees of the department.
2. 1. The department shall conform to federal standards for a merit system of personnel administration in any respects necessary for receiving federal grants, and the board is authorized and empowered to effect such changes as may, from time to time, be necessary in order to comply with such standards.
   2. The department is authorized to employ, on a full-time or part-time basis, such medical, supervisory, institutional, and other professional personnel and such clerical and other employees as may be necessary to discharge the duties of the department under this chapter. The department is also authorized to contract for such professional services as may be necessary.
   3. Classified employees of the department under this chapter shall in all instances be employed and dismissed in accordance with rules of the State Personnel Board.
   4. All personnel of the department are authorized to be members of the Employees' Retirement System of Georgia as provided in Chapter 2 of Title 47. All rights, credits, and funds in that retirement system which are possessed by state personnel transferred by provisions of this chapter to the department, or otherwise had by persons at the time of employment with the department, are continued and preserved, it being the intention of the General Assembly that such persons shall not lose any rights, credits, or funds to which they may be entitled prior to becoming employees of the department.
3. The department shall succeed to all rules, regulations, policies, procedures, and administrative orders of the predecessor agency or unit which were in effect on June 30, 2009, or scheduled to go into effect on or after July 1, 2009, and which relate to the functions transferred to the department by this chapter. Such rules, regulations, policies, procedures, and administrative orders shall remain in effect until amended, repealed, superseded, or nullified by proper authority or as otherwise provided by law. Rules of the department shall be adopted, promulgated, and implemented as provided in Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," except that only rules promulgated pursuant to Chapter 6 of this title shall be subject to the provisions of Code Section 31-6-21.1.
4. The rights, privileges, entitlements, and duties of parties to contracts, leases, agreements, and other transactions entered into before July 1, 2009, by any predecessor agency or unit and which pertain to the functions transferred to the department by this chapter shall continue to exist; and none of these rights, privileges, entitlements, and duties are impaired or diminished by reason of the transfer of the functions to the department. In all such instances, the Department of Community Health shall be substituted for the predecessor agency or unit, and the Department of Community Health shall succeed to the rights and duties under such contracts, leases, agreements, and other transactions.
5. On July 1, 2009, the department shall receive custody of the state owned real property in the custody of the predecessor agency or unit on June 30, 2009, and which pertains to the functions transferred to the department by this chapter. (Code 1981, § 31-5A-5, enacted by Ga. L. 1999, p. 296, § 1; Ga. L. 2001, p. 1240, § 2; Code 1981, § 31-2-5 , as redesignated by Ga. L. 2009, p. 453 § 1-1/HB 228; Ga. L. 2009, p. 745, § 2/SB 97; Ga. L. 2012, p. 446, § 2-33/HB 642.)

Editor's notes. - Ga. L. 2009, p. 453, § 1-1/HB 228, effective July 1, 2009, redesignated former Code Section 31-2-5 as present Code Section 31-2-10.

Ga. L. 2012, p. 446, § 3-1/HB 642, not codified by the General Assembly, provides that: "Personnel, equipment, and facilities that were assigned to the State Personnel Administration as of June 30, 2012, shall be transferred to the Department of Administrative Services on the effective date of this Act." This Act became effective July 1, 2012.

Ga. L. 2012, p. 446, § 3-2/HB 642, not codified by the General Assembly, provides that: "Appropriations for functions which are transferred by this Act may be transferred as provided in Code Section 45-12-90."

31-2-6. Commissioner of community health created; creation of divisions; allocation of functions.

1. There is created the position of commissioner of community health. The commissioner shall be the chief administrative officer of the department and shall be subject to appointment and removal by the Governor. Subject to the general policy established by the board, the commissioner shall supervise, direct, account for, organize, plan, administer, and execute the functions vested in the department.
2. There shall be created in the department such divisions as may be found necessary for its effective operation. The commissioner shall have the power to allocate and reallocate functions among the divisions within the department. (Code 1981, § 31-5A-6, enacted by Ga. L. 1999, p. 296, § 1; Code 1981, § 31-2-6 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228; Ga. L. 2011, p. 705, § 4-3/HB 214; Ga. L. 2011, p. 752, § 31/HB 142.)

Editor's notes. - Ga. L. 2009, p. 453, § 1-1/HB 228, effective July 1, 2009, redesignated former Code Section 31-2-6 as present Code Section 31-2-11.

Ga. L. 2011, p. 752, § 54(e)/HB 142, not codified by the General Assembly, provides that: "In the event of an irreconcilable conflict between a provision in Sections 1 through 53 of this Act and a provision of another Act enacted at the 2011 regular session of the General Assembly, the provision of such other Act shall control over the conflicting provision in Sections 1 through 53 of this Act to the extent of the conflict." Accordingly, the amendment to subsection (b) of this Code section by Ga. L. 2011, p. 752, § 31(1)/HB 142, was not given effect.

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011). For article, "Health: Department of Public Health," see 28 Ga. St. U. L. Rev. 147 (2011).

31-2-7. (See Editor's notes.) Rules and regulations; variances and waivers to rules and regulations establishing licensure standards for facilities; exemption of classes of facilities from regulation.

1. The department is authorized to adopt and promulgate rules and regulations to effect prevention, abatement, and correction of situations and conditions which, if not promptly checked, would militate against the health of the people of this state. Such rules and regulations shall be adapted to the purposes intended, within the purview of the powers and duties imposed upon the department by this chapter, and supersede conflicting rules, regulations, and orders adopted pursuant to the authority of Chapter 3 of this title.
2. The department upon application or petition may grant variances and waivers to specific rules and regulations which establish standards for facilities or entities regulated by the department as follows:
   1. The department may authorize departure from the literal requirements of a rule or regulation by granting a variance upon a showing by the applicant or petitioner that the particular rule or regulation that is the subject of the variance request should not be applied as written because strict application would cause undue hardship. The applicant or petitioner additionally must show that adequate standards affording protection of health, safety, and care exist and will be met in lieu of the exact requirements of the rule or regulation in question;
   2. The department may dispense entirely with the enforcement of a rule or regulation by granting a waiver upon a showing by the applicant or petitioner that the purpose of the rule or regulation is met through equivalent standards affording equivalent protection of health, safety, and care;
   3. The department may grant waivers and variances to allow experimentation and demonstration of new and innovative approaches to delivery of services upon a showing by the applicant or petitioner that the intended protections afforded by the rule or regulation which is the subject of the request are met and that the innovative approach has the potential to improve service delivery;
   4. Waivers or variances which affect an entire class of facilities may only be approved by the Board of Community Health and shall be for a time certain, as determined by the board. A notice of the proposed variance or waiver affecting an entire class of facilities shall be made in accordance with the requirements for notice of rule making in Chapter 13 of Title 50, the "Georgia Administrative Procedure Act"; or
   5. Variances or waivers which affect only one facility in a class may be approved or denied by the department and shall be for a time certain, as determined by the department. The department shall maintain a record of such action and shall make this information available to the board and all other persons who request it.

      This subsection shall not apply to rules adopted by the department pursuant to Code Section 31-6-21.1.

3. The department may exempt classes of facilities from regulation when, in the department's judgment, regulation would not permit the purpose intended or the class of facilities is subject to similar requirements under other rules and regulations. Such exemptions shall be provided in rules and regulations promulgated by the board. (Code 1933, § 88-110, enacted by Ga. L. 1964, p. 499, § 1; Code 1981, § 31-2-4 ; Ga. L. 1982, p. 1592, §§ 1, 2; Ga. L. 1990, p. 791, § 1; Ga. L. 2003, p. 569, § 1; Code 1981, § 31-2-9 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228; Code 1981, § 31-2-7 , as redesignated by Ga. L. 2011, p. 705, § 4-4/HB 214.)

Editor's notes. - Ga. L. 2009, p. 453, § 1-1, effective July 1, 2009, redesignated former Code Section 31-2-7 as present Code Section 31-2-12.

Ga. L. 2011, p. 705, § 3-2/HB 214, effective July 1, 2011, redesignated former Code Section 31-2-7 as present Code Section 31-2A-8.

For application of this statute in 2020, see Executive Order 03.20.20.02.

A listing of Executive Orders issued in 2020 can be found at https://gov.georgia.gov/executive-action/executive-orders/2020-executive-orders.

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-2-8. Actions against certain applicants or licensees.

1. This Code section shall be applicable to any agency, center, facility, institution, community living arrangement, drug abuse treatment and education program, or entity subject to regulation by the department under Chapters 7, 13, 22, 23, and 44 of this title; Chapter 5 of Title 26; paragraph (8) of subsection (d) of Code Section 31-2-4; and Article 7 of Chapter 6 of Title 49. For purposes of this Code section, the term "license" shall be used to refer to any license, permit, registration, or commission issued by the department pursuant to the provisions of the law cited in this subsection.
2. The department shall have the authority to take any of the actions enumerated in subsection (c) of this Code section upon a finding that the applicant or licensee has:
   1. Knowingly made any false statement of material information in connection with the application for a license, or in statements made or on documents submitted to the department as part of an inspection, survey, or investigation, or in the alteration or falsification of records maintained by the agency, facility, institution, or entity;
   2. Failed or refused to provide the department with access to the premises subject to regulation or information pertinent to the initial or continued licensing of the agency, facility, institution, or entity;
   3. Failed to comply with the licensing requirements of this state; or
   4. Failed to comply with any provision of this Code section.
3. When the department finds that any applicant or licensee has violated any provision of subsection (b) of this Code section or laws, rules, regulations, or formal orders related to the initial or continued licensing of the agency, facility, institution, or entity, the department, subject to notice and opportunity for hearing, may take any of the following actions:
   1. Refuse to grant a license; provided, however, that the department may refuse to grant a license without holding a hearing prior to taking such action;
   2. Administer a public reprimand;
   3. Suspend any license for a definite period or for an indefinite period in connection with any condition which may be attached to the restoration of said license;
   4. Prohibit any applicant or licensee from allowing a person who previously was involved in the management or control, as defined by rule, of any agency, facility, institution, or entity which has had its license or application revoked or denied within the past 12 months to be involved in the management or control of such agency, facility, institution, or entity;
   5. Revoke any license;
   6. 1. Except as otherwise provided in subparagraph (B) of this paragraph, impose a fine of up to $2,000.00 per day for each violation of a law, rule, regulation, or formal order related to the initial or ongoing licensing of any agency, facility, institution, or entity, up to a total of $40,000.00;
      2. Impose a mandatory fine of no less than $5,000.00 for a violation of a law, rule, regulation, or formal order related to the initial or ongoing licensing of long-term care facility which has caused the death of or serious physical harm to a resident in such facility. For purposes of this subparagraph, the term 'serious physical harm' means an injury which causes any significant impairment of the physical condition of the resident as determined by qualified medical personnel;
      3. No fine may be imposed pursuant to this paragraph against any nursing facility, nursing home, or intermediate care facility which is subject to intermediate sanctions under the provisions of 42 U.S.C. Section 1396r(h)(2)(A), as amended, whether or not those sanctions are actually imposed; or
   7. Limit or restrict any license as the department deems necessary for the protection of the public, including, but not limited to, restricting some or all services of or admissions into an agency, facility, institution, or entity for a time certain.

      In taking any of the actions enumerated in this subsection, the department shall consider the seriousness of the violation, including the circumstances, extent, and gravity of the prohibited acts, and the hazard or potential hazard created to the health or safety of the public.

4. 1. With respect to any facility classified as a nursing facility, nursing home, or intermediate care home, the department may not take an action to fine or restrict the license of any such facility based on the same act, occurrence, or omission for which:
      1. The facility has received an intermediate sanction under the provisions of 42 U.S.C. Section 1396r(h)(2)(A), as amended, or 42 U.S.C. Section 1395i-3(h)(2)(B); or
      2. Such facility has been served formal notice of intent to take such a sanction which the department based on administrative review or any other appropriate body based on administrative or judicial review determines not to impose; provided, however, that nothing in this subsection shall prohibit the department from utilizing the provisions authorized under subsection (f) of this Code section.
   2. When any civil monetary penalty is recommended and imposed against such facility, and the department does not resurvey the facility within 48 hours after the date by which all items on a plan of correction submitted by the facility are to be completed, the accrual of any resulting civil monetary penalties shall be suspended until the facility is resurveyed by the department.
   3. If the department resurveys such facility beyond 48 hours after the final date for completion of all items on the plan of correction submitted by the facility, and the facility is not in substantial compliance with the applicable standards, any civil monetary penalties imposed shall relate back to the date on which such penalties were suspended.
   4. Notwithstanding the provisions of paragraphs (2) and (3) of this subsection, nothing contained in said paragraphs shall be construed as requiring the state survey agency to act in violation of applicable federal law, regulations, and guidelines.
5. The department may deny a license or otherwise restrict a license for any applicant who has had a license denied, revoked, or suspended within one year of the date of an application or who has transferred ownership or governing authority of an agency, facility, institution, or entity subject to regulation by the department within one year of the date of a new application when such transfer was made in order to avert denial, revocation, or suspension of a license or to avert the payment of fines assessed by the department pursuant to this Code section.
6. With regard to any contested case instituted by the department pursuant to this Code section or other provisions of law which may now or hereafter authorize remedial or disciplinary grounds and action, the department may, in its discretion, dispose of the action so instituted by settlement. In such cases, all parties, successors, and assigns to any settlement agreement shall be bound by the terms specified therein, and violation thereof by any applicant or licensee shall constitute grounds for any action enumerated in subsection (c) of this Code section.
7. The department shall have the authority to make public or private investigations or examinations inside or outside of this state to determine whether the provisions of this Code section or any other law, rule, regulation, or formal order relating to the licensing of any agency, facility, institution, or entity has been violated. Such investigations may be initiated at any time, in the discretion of the department, and may continue during the pendency of any action initiated by the department pursuant to subsection (c) of this Code section.
8. For the purpose of conducting any investigation, inspection, or survey, the department shall have the authority to require the production of any books, records, papers, or other information related to the initial or continued licensing of any agency, facility, institution, or entity.
9. Pursuant to the investigation, inspection, and enforcement powers given to the department by this Code section and other applicable laws, the department may assess against an agency, facility, institution, or entity reasonable and necessary expenses incurred by the department pursuant to any administrative or legal action required by the failure of the agency, facility, institution, or entity to fully comply with the provisions of any law, rule, regulation, or formal order related to the initial or continued licensing. Assessments shall not include attorney's fees and expenses of litigation, shall not exceed other actual expenses, and shall only be assessed if such investigations, inspection, or enforcement actions result in adverse findings, as finally determined by the department, pursuant to administrative or legal action.
10. For any action taken or any proceeding held under this Code section or under color of law, except for gross negligence or willful or wanton misconduct, the department, when acting in its official capacity, shall be immune from liability and suit to the same extent that any judge of any court of general jurisdiction in this state would be immune.
11. In an administrative or legal proceeding under this Code section, a person or entity claiming an exemption or an exception granted by law, rule, regulation, or formal order has the burden of proving this exemption or exception.
12. This Code section and all actions resulting from its provisions shall be administered in accordance with Chapter 13 of Title 50, the "Georgia Administrative Procedure Act."
13. The provisions of this Code section shall be supplemental to and shall not operate to prohibit the department from acting pursuant to those provisions of law which may now or hereafter authorize remedial or disciplinary grounds and action for the department. In cases where those other provisions of law so authorize other disciplinary grounds and actions, but this Code section limits such grounds or actions, those other provisions shall apply.
14. The department is authorized to promulgate rules and regulations to implement the provisions of this Code section. (Code 1981, § 31-2-6 , enacted by Ga. L. 1991, p. 341, § 1; Ga. L. 1993, p. 1290, § 1; Ga. L. 1994, p. 1856, § 1; Ga. L. 1999, p. 296, § 24; Ga. L. 2000, p. 526, § 2; Ga. L. 2001, p. 1230, § 1; Ga. L. 2003, p. 298, § 2; Ga. L. 2003, p. 558, § 1; Code 1981, § 31-2-11 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228; Code 1981, § 31-2-8 , as redesignated by Ga. L. 2011, p. 705, § 4-4/HB 214; Ga. L. 2020, p. 95, § 3/HB 987.)

The 2020 amendment, effective June 30, 2020, rewrote paragraph (c)(6), which read: "Impose a fine, not to exceed a total of $25,000.00, of up to $1,000.00 per day for each violation of a law, rule, regulation, or formal order related to the initial or ongoing licensing of any agency, facility, institution, or entity, except that no fine may be imposed against any nursing facility, nursing home, or intermediate care facility which is subject to intermediate sanctions under the provisions of 42 U.S.C. Section 1396r(h)(2)(A), as amended, whether or not those sanctions are actually imposed; or"; and added "or to avert the payment of fines assessed by the department pursuant to this Code section" at the end of subsection (e).

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1991, "42 U.S.C. Section 1396r(h)(2)(A)" was substituted for "42 U.S.C. Section 1396r(h)(2)(a)" in paragraph (c)(6).

Pursuant to Code Section 28-9-5, in 2000, "44" was substituted for "43" in subsection (a).

Pursuant to Code Section 28-9-5, in 2006, the substitution of "23, and 44" for "and 23" was retained in subsection (a) due to the elimination of the repeal of T. 31, Ch. 44, in accordance with Ga. L. 2005, p. 1194, § 1.

Editor's notes. - Ga. L. 2003, p. 298, § 3(b), not codified by the General Assembly, provided that the first 2003 amendment became effective July 1 of the fiscal year following the year in which funds are specifically appropriated for the purposes of this Act in an appropriations Act making specific reference to this Act and shall become effective when funds so appropriated become available for expenditure. Funds were appropriated at the 2007 session of the General Assembly, and thus the first 2003 amendment became effective July 1, 2008.

Ga. L. 2005, p. 1194, § 1/SB 48, not codified by the General Assembly, provides: "(b) The following provision of law is repealed:

Section 4 of an Act amending Title 31 of the Official Code of Georgia Annotated, relating to health, approved April 20, 2000 (Ga. L. 2000, p. 526), which now repealed section would have provided for a future repeal or sunset of certain provisions relating to renal dialysis facilities." This 2005 law effectively repeals the automatic repeal provision of Ga. L. 2000, p. 526.

Ga. L. 2011, p. 705, § 3-2/HB 214, effective July 1, 2011, redesignated former Code Section 31-2-8 as present Code Section 31-2A-9.

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011). For note on the 2001 amendment to this Code section, see 18 Ga. St. U. L. Rev. 158 (2001).

31-2-9. Records check requirement for certain health care facilities; definitions; use of information gathered in investigation; penalties for unauthorized release or disclosure; rules and regulations; retention of fingerprints.

Repealed by Ga. L. 2018, p. 611, § 1-1/SB 406, effective October 1, 2019.

Editor's notes. - This Code section was based on Ga. L. 2009, p. 453, § 1-1/HB 228; Ga. L. 2010, p. 878, § 31/HB 1387; Ga. L. 2011, p. 227, § 10/SB 178; Code 1981, § 31-2-9 , as redesignated by Ga. L. 2011, p. 705, § 4-4/HB 214; Ga. L. 2012, p. 351, § 2/HB 1110; Ga. L. 2013, p. 524, § 3-2/HB 78; Ga. L. 2014, p. 444, § 2-8/HB 271; Ga. L. 2015, p. 598, § 1-8/HB 72; Ga. L. 2018, p. 507, § 2-6/SB 336.

31-2-10. Information and comparisons regarding state-wide cost and quality of health care.

Performance and outcome data and pricing data for selected medical conditions, surgeries, and procedures in hospitals, ambulatory surgery centers, nursing homes, and rehabilitation centers in Georgia shall be reported to the Department of Community Health on a regular basis. The department shall provide for the establishment of a website for the purpose of providing consumers information on the cost and quality of health care in Georgia to include but not be limited to cost comparison information on certain prescription drugs at different pharmacies in Georgia, hospitals, ambulatory surgery centers, nursing homes, and rehabilitation centers and facilities in Georgia.

(Code 1981, § 31-5A-7, enacted by Ga. L. 2007, p. 133, § 19/HB 24; Ga. L. 2008, p. 324, § 31/SB 455; Code 1981, § 31-2-15 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228; Code 1981, § 31-2-10 , as redesignated by Ga. L. 2011, p. 705, § 4-4/HB 214.)

Editor's notes. - Ga. L. 2007, p. 133, § 1/HB 24, not codified by the General Assembly, provides: "(a) The General Assembly has long recognized the right of the individual to control all aspects of his or her personal care and medical treatment, including the right to insist upon medical treatment, decline medical treatment, or direct that medical treatment be withdrawn. In order to secure these rights, the General Assembly has adopted and amended statutes recognizing the living will and health care agency and provided statutory forms for both documents.

"(b) The General Assembly has determined that the statutory forms for the living will and durable power of attorney for health care are confusing and inconsistent and that the statutes providing for the living will and health care agency contain conflicting concepts, inconsistent and out-of-date terminology, and confusing and inconsistent requirements for execution. In addition, there is a commendable trend among the states to combine the concepts of the living will and health care agency into a single legal document.

"(c) The General Assembly recognizes that a significant number of individuals representing the academic, medical, legislative, and legal communities, state officials, ethics scholars, and advocacy groups worked together to develop the advance directive for health care contained in this Act, and the collective intent was to create a form that uses understandable and everyday language in order to encourage more citizens of this state to execute advance directives for health care.

"(d) The General Assembly finds that the clear expression of an individual's decisions regarding health care, whether made by the individual or an agent appointed by the individual, is of critical importance not only to citizens but also to the health care and legal communities, third parties, and families. In furtherance of these purposes, the General Assembly enacts a new Chapter 32 of Title 31, setting forth general principles governing the expression of decisions regarding health care and the appointment of a health care agent, as well as a form of advance directive for health care."

Ga. L. 2011, p. 705, § 3-2/HB 214, effective July 1, 2011, redesignated former Code Section 31-2-10 as present Code Section 31-2A-10.

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011). For article, "Health: Department of Public Health," see 28 Ga. St. U. L. Rev. 147 (2011).

31-2-11. Biopharmaceuticals; expedited review for Georgia based companies.

1. As used in this Code section, the term:
   1. "Biopharmaceutical" means the application of biotechnology to the development of pharmaceutical products that improve human health.
   2. "Biotechnology" means any technological application that uses biological systems, living organisms, or derivatives thereof to make or modify products or processes for specific use.
   3. "Georgia biotechnology, biopharmaceutical, or pharmaceutical company" means a biotechnology, biopharmaceutical, or pharmaceutical company, or a corporate division of such a company:
      1. The principal activity of which is research or development, manufacturing, or sales of health care products in this state; and
      2. 1. That had a total economic impact in this state of not less than $60 million during the most recent taxable year;
         2. That has total capital investment in this state of not less than $100 million; and
         3. That employs at least 200 Georgia residents.

            Such term shall not mean a warehouse used to store health care products.

   4. "Pharmaceutical" means of or pertaining to the knowledge or art of pharmacy or to the art of preparing medicines according to the rules or formulas of pharmacy.
   5. "Research and development" means experimental or laboratory activity for the ultimate purpose of developing new products, improving existing products, developing new uses for existing products, or developing or improving methods for producing products.
   6. "Total economic impact" means the sum of total employee payroll, investment in external research and development, the value of prescription drug samples provided to physicians, and the value of prescription drugs donated to low-income individuals through patient assistance programs.
2. The Department of Community Health shall expedite the review of any prescription drug or other health care product having an approved indication from the federal Food and Drug Administration for use with humans and that is produced by a Georgia biotechnology, biopharmaceutical, or pharmaceutical company for any health care coverage provided under the state health benefit plan under Article 1 of Chapter 18 of Title 45, the medical assistance program under Article 7 of Chapter 4 of Title 49, the PeachCare for Kids Program under Article 13 of Chapter 5 of Title 49, or any other health benefit plan or policy administered by or on behalf of the state. Such review shall take place as soon as practicable following the date that such drug or health care product becomes available for public consumption. This subsection shall apply to all contracts entered into or renewed by the Department of Community Health on or after July 1, 2008.
3. In complying with the provisions of this Code section, the department shall consider the nexus of a biotechnology, biopharmaceutical, or pharmaceutical company in relation to the state along with the financial impact on the state, the quality of the product, and other relevant factors. (Code 1981, § 31-5A-8, enacted by Ga. L. 2008, p. 121, § 1/HB 180; Ga. L. 2009, p. 8, § 31/SB46; Code 1981, § 31-2-16 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228; Code 1981, § 31-2-11 , as redesignated by Ga. L. 2011, p. 705, § 4-4/HB 214; Ga. L. 2012, p. 775, § 31/HB 942.)

Editor's notes. - Ga. L. 2011, p. 705, § 4-4/HB 214, effective July 1, 2011, redesignated former Code Section 31-2-11 as present Code Section 31-2-8.

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-2-12. Pilot program to provide coverage for bariatric surgical procedures for treatment of obesity and related conditions; definitions; eligibility; requirements; evaluation report on two-year pilot program.

Reserved. Repealed by Ga. L. 2014, p. 172, § 1/HB 511, effective December 31, 2018.

Editor's notes. - This Code section was based on Code 1981, § 31-2-12 , enacted by Ga. L. 2014, p. 172, § 1/HB 511.

Ga. L. 2019, p. 1056, § 31(3)/SB 52, effective May 12, 2019, part of an Act to revise, modernize, and correct the Code, designated this Code section as reserved.

31-2-13. Inspection warrant.

1. As used in this Code section, the term "commissioner" means the commissioner of community health or his or her designee.
2. Nothing in this Code section shall be construed to require an inspection warrant when a warrantless inspection is authorized by law or pursuant to a rule or regulation enacted pursuant to this title.
3. An inspection warrant is an order, in writing, signed by a judicial officer, directed to the commissioner or any person authorized to make inspections for such commissioner and commanding him or her to conduct an inspection required or authorized by:
   1. This title;
   2. Any other law administered by the commissioner;
   3. Rules or regulations promulgated pursuant to this title; or
   4. Rules or regulations promulgated pursuant to any other law administered by the commissioner.
4. The commissioner or any person authorized to make inspections for such commissioner shall make application for an inspection warrant to a person who is a judicial officer within the meaning of Code Section 17-5-21.
5. 1. An inspection warrant shall be issued only upon cause and when supported by an affidavit which:
      1. Particularly describes the place, dwelling, structure, premises, or vehicle to be inspected;
      2. Particularly describes the purpose for which the inspection is to be made; and
      3. Contains either a statement that consent to inspect has been sought and refused or facts or circumstances reasonably justifying the failure to seek such consent.
   2. Cause to support the issuance of an inspection warrant shall be deemed to exist if:
      1. Reasonable legislative or administrative standards for conducting a routine or area inspection are satisfied with respect to the particular place, dwelling, structure, premises, or vehicle; or
      2. There is reason to believe that a condition of nonconformity exists with respect to the particular place, dwelling, structure, premises, or vehicle.
6. An inspection warrant shall be effective for the time specified therein, but not for a period of more than 14 days, unless extended or renewed by the judicial officer who signed and issued the original warrant, upon satisfaction that such extension or renewal is in the public interest. Such inspection warrant shall be executed and returned to the judicial officer by whom it was issued within the time specified in such warrant or within the extended or renewed time. After the expiration of such time, the inspection warrant, unless executed, shall be void.
7. An inspection pursuant to an inspection warrant:
   1. May be executed at any time as deemed appropriate by the individual executing such warrant but whenever possible shall be made at any time during operating or regular business hours;
   2. Should not be performed in the absence of an owner or occupant of the particular place, dwelling, structure, premises, or vehicle being inspected unless specifically authorized by the judicial officer upon a showing that such authority is reasonably necessary to effectuate the purpose of the law, rule, or regulation being enforced; and
   3. Shall not be made by means of forcible entry, except that the judicial officer may expressly authorize a forcible entry when facts are shown:
      1. Which are sufficient to create a reasonable suspicion of a violation of this title or any other law, rule, or regulation administered by the commissioner or the department, which, if such violation existed, would be an immediate threat to health or safety; or
      2. Establishing that a reasonable attempt to serve a previous inspection warrant has been unsuccessful.
8. When prior consent for an inspection has been sought and refused and an investigation warrant has been issued, an inspection warrant may be executed without further notice to the owner or occupant of the particular place, dwelling, structure, premises, or vehicle being inspected.
9. It shall be unlawful for any owner, operator, or employee of the particular place, dwelling, structure, premises, or vehicle being inspected to refuse to allow an inspection pursuant to an inspection warrant issued as provided in this Code section. Any person violating this Code section shall be guilty of a misdemeanor. (Code 1981, § 31-2-13 , enacted by Ga. L. 2015, p. 598, § 1-9/HB 72.)

Law reviews. - For article on the 2015 enactment of this Code section, see 32 Ga. St. U. L. Rev. 63 (2015).

31-2-14. Nurse aide registry; complaint filing; public access.

1. The nurse aide registry established and maintained by the department as required by 42 C.F.R. Section 483.156 shall include, in addition to nurse aides who work in licensed facilities, nurse aides who provide services in this state in temporary or permanent private residences.
2. The registry shall provide a method for an inquiry or complaint to be submitted by the public regarding a nurse aide providing services in private residences. Any such inquiries or complaints shall be handled in the same manner as required for nurse aides who work in licensed facilities.
3. The department shall ensure that the registry is posted or a link to it is provided in a prominent location on the department's website. (Code 1981, § 31-2-14 , enacted by Ga. L. 2016, p. 201, § 1/HB 1037.)

Editor's notes. - Ga. L. 2011, p. 705, § 4-4/HB 214, effective July 1, 2011, redesignated former Code Section 31-2-14 as present Code Section 31-2-9.

31-2-15. Streamlining and expediting credentialing and billing processes.

1. As used in this Code section, the term "state medical plan" means the state health benefit plan under Article 1 of Chapter 18 of Title 45, the medical assistance program under Article 7 of Chapter 4 of Title 49, the PeachCare for Kids Program under Article 13 of Chapter 5 of Title 49, and any other health benefit plan or policy administered by or on behalf of the state.
2. The department shall take all reasonable steps to streamline and expedite the credentialing and billing processes for state medical plans, including but not limited to examining the potential for a uniform billing platform or portal; examining the potential for the standardization of billing codes among providers; posting billing criteria and codes on the department's website; enabling a dual track process for credentialing and contract negotiation for new providers; allowing billing for telehealth delivered care and allowing payment for both the on-site provider and off-site provider; and maximizing billing for multiple specialists and multiple encounters with one provider at a single visit in safety net settings, critical access settings, federally qualified health centers, and general practitioner settings.
3. This Code section shall not be construed to require the department to act in violation of any federal law, rule, or regulation. (Code 1981, § 31-2-15 , enacted by Ga. L. 2018, p. 132, § 3B/HB 769.)

Effective date. - This Code section became effective July 1, 2018.

Editor's notes. - Ga. L. 2011, p. 705, § 4-4/HB 214, effective July 1, 2011, redesignated former Code Section 31-2-15 as present Code Section 31-2-10.

Ga. L. 2018, p. 132, § 8(c)/HB 769, not codified by the General Assembly, provides: "(c)(1) Section 3A of this Act shall become effective on July 1, 2018, only if SB 357 or another Act creating the Health Coordination and Innovation Council is enacted by the General Assembly and becomes law in 2018, in which event Section 3B of this Act shall not become effective and shall stand repealed on July 1, 2018.

"(2) If SB 357 or another Act creating the Health Coordination and Innovation Council does not become law in 2018, then Section 3B of this Act shall become effective on July 1, 2018, and Section 3A of this Act shall not become effective and shall stand repealed on July 1, 2018." SB 357 was passed by the General Assembly but was vetoed by the Governor on May 8, 2018, and did not become law.

31-2-16. Rural Health System Innovation Center created; purposes and duties; reporting.

1. There is created and established the Rural Health System Innovation Center within the department's State Office of Rural Health to serve as a research organization that utilizes Georgia's academic, public health policy, data, and workforce resources to develop new approaches for financing and delivering health care in this state. The department shall release a request for proposals, no later than December 1, 2018, to identify a postsecondary institution within the state in which the center shall be located. Such postsecondary institution shall have a health program or college that focuses on rural and underserved areas of the state. The department shall reissue a request for proposal after seven years and every five years thereafter.
2. The purposes and duties of the Rural Health System Innovation Center shall be to:
   1. Develop a research program to identify and analyze significant health system problems and to propose solutions and best practices to such problems;
   2. Focus on access improvement to affordable health care in rural Georgia;
   3. Synthesize existing studies, reports, and data to provide a baseline assessment and set measurable goals as part of Georgia's strategic reform plan;
   4. Incorporate recommendations from state reform efforts to build the state's reform plan;
   5. Evaluate and make recommendations for the fiscal stabilization of rural health care delivery systems and ensure their design is appropriate for the community served by such systems;
   6. Provide technical assistance and expertise to address immediate needs of rural communities;
   7. Develop state-wide pilot projects, identify innovative approaches to funding these projects, and track and evaluate the projects' performance;
   8. Connect to a central health data repository for collection and dissemination of health data and serve as a clearinghouse for data integration and analysis;
   9. Produce studies that address cost-drivers and duplication to eliminate barriers to health care and reduce costs;
   10. Monitor current and future health care workforce needs and advise the Georgia Board of Health Care Workforce of significant changes in need or demand;
   11. Participate in other state-wide health initiatives or programs affecting the entire state and nonrural areas of Georgia. The center shall cooperate with other health related state entities, including but not limited to the department, the Department of Public Health, the Department of Human Services, the Department of Behavioral Health and Developmental Disabilities, and the Office of Health Strategy and Coordination and all other health related state boards, commissions, committees, councils, offices, and other entities on state-wide health initiatives or programs; and
   12. 1. In conjunction with the State Office of Rural Health, develop standards for education curriculum no later than January 1, 2019, which will be provided to leadership, including, but not limited to, hospital executive leadership, hospital board members, and hospital authority members of rural hospital organizations, as defined in Code Section 31-8-9.1, and to other rural health care facilities upon request. The curriculum shall include, at a minimum, legal, fiduciary, grant management, planning, and compliance training. The center shall approve education programs by any entity that the center determines to meet such standards.
       2. The chief executive officer, the chief financial officer, every board member, and every hospital authority member, if operated by a hospital authority pursuant to Article 4 of Chapter 7 of this title, of a rural hospital organization as defined in Code Section 31-8-9.1, shall be required to complete an education program approved by the center pursuant to this paragraph no later than December 31, 2020, or within 12 months of initial hiring or appointment and every two years thereafter.
       3. Any board member or hospital authority member who does not complete the education program as required pursuant to subparagraph (B) of this paragraph shall be ineligible to continue serving as a board member or hospital authority member. The center may provide for notice and a grace period for board members and hospital authority members to come into compliance with such requirement. A vacancy created pursuant to this subparagraph on the board of a hospital authority shall be filled in the same manner as provided in subsection (c) of Code Section 31-7-72 for the initial appointment of members of the hospital authority.
       4. At the discretion of the department, any rural hospital organization that fails to ensure compliance by the chief executive officer, the chief financial officer, every board member, and every hospital authority member with the education requirements contained in subparagraph (B) of this paragraph shall be deemed:
          1. Ineligible to receive contributions from the tax credit provided pursuant to Code Section 48-7-29.20;
          2. Ineligible to participate in any grant programs offered by the state; and
          3. Subject to a fine of $10,000.00 per violation.
3. The center is authorized to make application for and receive funds and grants as may be necessary to, and utilize and disburse such funds for such purposes and projects as will, carry out the purposes of the center.
4. The center is authorized to enter into contracts, agreements, and arrangements with colleges and universities to advance the work of the center. The center shall also be authorized to enter into contracts and agreements with the federal government; political subdivisions of this state; private firms, foundations, or institutions; or individuals for specific research on any aspects of rural health care as may be related to the purposes of this Code section. The center shall contract with a school of medicine in this state to provide clinical health care expertise to the center.
5. On or before October 1 of each year, the center shall file a report to the Governor, the President of the Senate, the Speaker of the House of Representatives, and the chairpersons of the House Committee on Health and Human Services, the Senate Health and Human Services Committee, the House Committee on Appropriations, the Senate Appropriations Committee, and the Office of Health Strategy and Coordination. The report shall include a summary of the activities of the center during the calendar year, including but not limited to the total number of hospital executives, hospital board members, and hospital authority members who received training from the center; the status of rural health care in the state; and recommendations, if any, for legislation as may be necessary to improve the programs and services offered by the center. (Code 1981, § 31-2-16 , enacted by Ga. L. 2018, p. 132, § 3B/HB 769; Ga. L. 2019, p. 148, § 2-4/HB 186; Ga. L. 2019, p. 224, § 2/SB 207; Ga. L. 2019, p. 1056, § 31/SB 52.)

Effective date. - This Code section became effective July 1, 2018.

The 2019 amendments. The first 2019 amendment, effective July 1, 2019, deleted commas following "including" and "limited to" in the middle of the second sentences of paragraph (b)(11) and subsection (e); in paragraph (b)(11), in the second sentence, deleted "and" following "Department of Human Services" and inserted "and the Office of Health Strategy and Coordination" in the middle; and, in the first sentence of subsection (e), deleted "and" preceding "the Senate Appropriations Committee", and added ", and the Office of Health Strategy and Coordination" at the end. The second 2019 amendment, effective July 1, 2019, substituted "Georgia Board of Health Care Workforce" for "Georgia Board for Physician Workforce" in paragraph (b)(10). The third 2019 amendment, effective May 12, 2019, part of an Act to revise, modernize, and correct the Code, revised punctuation in subparagraph (b)(12)(B).

Editor's notes. - Ga. L. 2011, p. 705, § 4-4/HB 214, effective July 1, 2011, redesignated former Code Section 31-2-16 as present Code Section 31-2-11.

Ga. L. 2018, p. 132, § 8(c)/HB 769, not codified by the General Assembly, provided: "(c)(1) Section 3A of this Act shall become effective on July 1, 2018, only if SB 357 or another Act creating the Health Coordination and Innovation Council is enacted by the General Assembly and becomes law in 2018, in which event Section 3B of this Act shall not become effective and shall stand repealed on July 1, 2018.

"(2) If SB 357 or another Act creating the Health Coordination and Innovation Council does not become law in 2018, then Section 3B of this Act shall become effective on July 1, 2018, and Section 3A of this Act shall not become effective and shall stand repealed on July 1, 2018." SB 357 was passed by the General Assembly but was vetoed by the Governor on May 8, 2018, and did not become law.

Ga. L. 2019, p. 148, § 2-1/HB 186, not codified by the General Assembly, provides: "This part shall be known and may be cited as 'The Health Act.'"

31-2-17. Redesignated.

Editor's notes. - Ga. L. 2011, p. 705, § 3-2/HB 214, effective July 1, 2011, redesignated former Code Section 31-2-17 as present Code Section 31-2A-13.

31-2-17.1. Redesignated.

Editor's notes. - Ga. L. 2011, p. 705, § 3-2/HB 214, effective July 1, 2011, redesignated former Code Section 31-2-17.1 as present Code Section 31-2A-14.

31-2-18. Redesignated.

Editor's notes. - Ga. L. 2011, p. 705, § 3-2/HB 214, effective July 1, 2011, redesignated former Code Section 31-2-18 as present Code Section 31-2A-15.

31-2-19. Advisory Council for Public Health; members; meetings.

Repealed by Ga. L. 2011, p. 705, § 4-5/HB 214, effective July 1, 2011.

Editor's notes. - This Code section was based on Code 1981, § 31-2-19 , enacted by Ga. L. 2009, p. 453, § 1-1/HB 228.

Law reviews. - For article on the 2011 repeal of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-2-20. Public Health Commission; members; purpose; authority.

Repealed by Ga. L. 2009, p. 453, § 1-1/HB 228, effective December 31, 2010.

Editor's notes. - This Code section was based on Code 1981, § 31-2-20 , enacted by Ga. L. 2009, p. 453, § 1-1/HB 228.

31-2A-1. Creation of Board of Public Health; powers, duties, and functions of Board of Community Health transferred to the Board of Public Health; board composition and terms; vacancies, removal; chairperson; reimbursement of expenses.

1. There is created the Board of Public Health which shall establish the general policy to be followed by the Department of Public Health. The powers, functions, and duties of the Board of Community Health as they existed on June 30, 2011, with regard to the Division of Public Health and the Office of Health Improvement, unless otherwise provided in this Act, are transferred to the Board of Public Health effective July 1, 2011. The board shall consist of nine members appointed by the Governor and confirmed by the Senate.
2. The Governor shall designate the initial terms of the members of the board as follows: three members shall be appointed for one year; three members shall be appointed for two years; and three members shall be appointed for three years. Thereafter, all succeeding appointments shall be for three-year terms from the expiration of the previous term.
3. Vacancies in office shall be filled by appointment by the Governor in the same manner as the appointment to the position on the board which becomes vacant. An appointment to fill a vacancy other than by expiration of a term of office shall be for the balance of the unexpired term.
4. Members of the board may be removed from office under the same conditions for removal from office of members of professional licensing boards provided in Code Section 43-1-17.
5. There shall be a chairperson of the board elected by and from the membership of the board who shall be the presiding officer of the board.
6. The members of the board shall receive the same daily expense allowance and reimbursement of expenses as provided in Code Section 45-7-21 for members of other state boards. (Code 1981, § 31-2A-1 , enacted by Ga. L. 2011, p. 705, § 3-1/HB 214.)

Law reviews. - For article, "Health: Department of Public Health," see 28 Ga. St. U. L. Rev. 147 (2011).

31-2A-2. Creation of Department of Public Health; transition of powers, function, and duties to new agency; commissioner of public health; creation of divisions.

1. There is created a Department of Public Health. The powers, functions, and duties of the Division of Public Health and the Office of Health Improvement of the Department of Community Health as they existed on June 30, 2011, unless otherwise provided in this Act, are transferred to the Department of Public Health effective July 1, 2011.
2. There is created the position of commissioner of public health. The commissioner shall be the chief administrative officer of the department and be both appointed and removed by the Governor. Subject to the general policy established by the board, the commissioner shall supervise, direct, account for, organize, plan, administer, and execute the functions vested in the department.
3. There shall be created in the department such divisions as may be found necessary for its effective operation. The commissioner shall have the power to allocate and reallocate functions among the divisions within the department. (Code 1981, § 31-2A-2 , enacted by Ga. L. 2011, p. 705, § 3-1/HB 214.)

Law reviews. - For article, "Health: Department of Public Health," see 28 Ga. St. U. L. Rev. 147 (2011).

31-2A-3. Department of Public Health successor to certain rules, regulations, policies, procedures, administrative orders, rights, interests, and obligations of Department of Community Health.

1. The Department of Public Health shall succeed to all rules, regulations, policies, procedures, and administrative orders of the Department of Community Health that are in effect on June 30, 2011, or scheduled to go into effect on or after July 1, 2011, and which relate to the functions transferred to the Department of Public Health pursuant to Code Section 31-2A-2 and shall further succeed to any rights, privileges, entitlements, obligations, and duties of the Department of Community Health that are in effect on June 30, 2011, which relate to the functions transferred to the Department of Public Health pursuant to Code Section 31-2A-2. Such rules, regulations, policies, procedures, and administrative orders shall remain in effect until amended, repealed, superseded, or nullified by the Department of Public Health by proper authority or as otherwise provided by law.
2. The rights, privileges, entitlements, and duties of parties to contracts, leases, agreements, and other transactions as identified by the Office of Planning and Budget entered into before July 1, 2011, by the Department of Community Health which relate to the functions transferred to the Department of Public Health pursuant to Code Section 31-2A-2 shall continue to exist; and none of these rights, privileges, entitlements, and duties are impaired or diminished by reason of the transfer of the functions to the Department of Public Health. In all such instances, the Department of Public Health shall be substituted for the Department of Community Health, and the Department of Public Health shall succeed to the rights and duties under such contracts, leases, agreements, and other transactions.
3. All persons employed by the Department of Community Health in capacities which relate to the functions transferred to the Department of Public Health pursuant to Code Section 31-2A-2 on June 30, 2011, shall, on July 1, 2011, become employees of the Department of Public Health in similar capacities, as determined by the commissioner of public health. Such employees shall be subject to the employment practices and policies of the Department of Public Health on and after July 1, 2011, but the compensation and benefits of such transferred employees shall not be reduced as a result of such transfer. Employees who are subject to the rules of the State Personnel Board and who are transferred to the department shall retain all existing rights under such rules. Accrued annual and sick leave possessed by the transferred employees on June 30, 2011, shall be retained by such employees as employees of the Department of Public Health.
4. On July 1, 2011, the Department of Public Health shall receive custody of the state owned real property in the custody of the Department of Community Health on June 30, 2011, and which pertains to the functions transferred to the Department of Public Health pursuant to Code Section 31-2A-2 . (Code 1981, § 31-2A-3 , enacted by Ga. L. 2011, p. 705, § 3-1/HB 214; Ga. L. 2012, p. 446, § 2-34/HB 642.)

Editor's notes. - Ga. L. 2012, p. 446, § 3-1/HB 642, not codified by the General Assembly, provides that: "Personnel, equipment, and facilities that were assigned to the State Personnel Administration as of June 30, 2012, shall be transferred to the Department of Administrative Services on the effective date of this Act." This Act became effective July 1, 2012.

Ga. L. 2012, p. 446, § 3-2/HB 642, not codified by the General Assembly, provides that: "Appropriations for functions which are transferred by this Act may be transferred as provided in Code Section 45-12-90."

31-2A-4. Obligation to safeguard and promote health of people of the state.

The Department of Public Health shall safeguard and promote the health of the people of this state and is empowered to employ all legal means appropriate to that end. Illustrating, without limiting, the foregoing grant of authority, the department is empowered to:

1. Provide epidemiological investigations and laboratory facilities and services in the detection and control of disease, disorders, and disabilities and to provide research, conduct investigations, and disseminate information concerning reduction in the incidence and proper control of disease, disorders, and disabilities;
2. Forestall and correct physical, chemical, and biological conditions that, if left to run their course, could be injurious to health;
3. Regulate and require the use of sanitary facilities at construction sites and places of public assembly and to regulate persons, firms, and corporations engaged in the rental and service of portable chemical toilets;
4. Isolate and treat persons afflicted with a communicable disease who are either unable or unwilling to observe the department's rules and regulations for the suppression of such disease and to establish, to that end, complete or modified quarantine, surveillance, or isolation of persons and animals exposed to a disease communicable to man;
5. Procure and distribute drugs and biologicals and purchase services from clinics, laboratories, hospitals, and other health facilities and, when authorized by law, to acquire and operate such facilities;
6. Cooperate with agencies and departments of the federal government and of the state by supplying consultant services in medical and hospital programs and in the health aspects of civil defense, emergency preparedness, and emergency response;
7. Prevent, detect, and relieve physical defects and deformities;
8. Promote the prevention, early detection, and control of problems affecting the dental and oral health of the citizens of Georgia;
9. Contract with county boards of health to assist in the performance of services incumbent upon them under Chapter 3 of this title and, in the event of grave emergencies of more than local peril, to employ whatever means may be at its disposal to overcome such emergencies;
10. Contract and execute releases for assistance in the performance of its functions and the exercise of its powers and to supply services which are within its purview to perform;
11. Enter into or upon public or private property at reasonable times for the purpose of inspecting same to determine the presence of disease and conditions deleterious to health or to determine compliance with health laws and rules, regulations, and standards thereunder;
12. Establish, by rule adopted pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," a schedule of fees for laboratory services provided, schedules to be determined in a manner so as to help defray the costs incurred by the department, but in no event to exceed such costs, both direct and indirect, in providing such laboratory services, provided no person shall be denied services on the basis of his or her inability to pay. All fees paid thereunder shall be paid into the general funds of the State of Georgia. The individual who requests the services authorized in this paragraph, or the individual for whom the laboratory services authorized in this paragraph are performed, shall be responsible for payment of the service fees. As used in this paragraph, the term "individual" means a natural person or his or her responsible health benefit policy or Title XVIII, XIX, or XXI of the federal Social Security Act of 1935;
13. Exchange data with the Department of Community Health for purposes of health improvement and fraud prevention for programs operated by the Department of Community Health pursuant to mutually agreed upon data sharing agreements and in accordance with federal confidentiality laws relating to health care;
14. Provide The Council of Superior Court Clerks of Georgia the data set forth in Code Section 15-12-40.1, without charge and in the electronic format requested; and
15. Maintain and administer the electronic prescription drug monitoring program data base established under Code Section 16-13-57 . (Code 1981, § 31-2A-4 , enacted by Ga. L. 2011, p. 705, § 3-1/HB 214; Ga. L. 2014, p. 451, § 10/HB 776; Ga. L. 2017, p. 319, § 1-5/HB 249.)

The 2017 amendment, effective July 1, 2017, deleted "and" at the end of paragraph (13), substituted "; and" for the period at the end of paragraph (14), and added paragraph (15).

Law reviews. - For note, "Don't Let the Bed Bugs Bill: Landlord Liability for Bed Bug Infestations," see 34 Ga. St. U. L. Rev. 479 (2018).

31-2A-5. Office of Women's Health; duties.

1. There is created in the department the Office of Women's Health.
2. The Office of Women's Health shall serve in an advisory capacity to the Office of Health Strategy and Coordination. In particular, the office shall:
   1. Raise awareness of women's nonreproductive health issues;
   2. Raise awareness of women's reproductive health issues;
   3. Inform and engage in prevention and education activities relating to women's nonreproductive health issues; and
   4. Serve as a clearing-house for women's health information for purposes of planning and coordination. (Code 1981, § 31-2A-5 , enacted by Ga. L. 2011, p. 705, § 3-1/HB 214; Ga. L. 2019, p. 148, § 2-5/HB 186; Ga. L. 2020, p. 55, § 4/SB 372.)

The 2019 amendment, effective July 1, 2019, substituted "Office of Health Strategy and Coordination" for "Governor, the General Assembly, the board, the department, and all other state agencies in matters relating to women's health" in the first sentence of subsection (b); and added subsection (d).

The 2020 amendment, effective July 1, 2020, deleted the second through seventh sentences in subsection (a); added paragraph (b)(2); redesignated former paragraphs (b)(2) and (b)(3) as present paragraphs (b)(3) and (4), respectively; deleted former paragraphs (b)(4) and (b)(5); and deleted former subsections (c) and (d).

Editor's notes. - Ga. L. 2019, p. 148, § 2-1/HB 186, not codified by the General Assembly, provides: "This part shall be known and may be cited as 'The Health Act.'"

31-2A-6. Rules and regulations.

1. The department is authorized to adopt and promulgate rules and regulations to effect prevention, abatement, and correction of situations and conditions which, if not promptly checked, would militate against the health of the people of this state. Such rules and regulations shall be adapted to the purposes intended, within the purview of the powers and duties imposed upon the department by this chapter, and supersede conflicting rules, regulations, and orders adopted pursuant to the authority of Chapter 3 of this title.
2. The department upon application or petition may grant variances and waivers to specific rules and regulations which establish standards for facilities or entities regulated by the department as follows:
   1. The department may authorize departure from the literal requirements of a rule or regulation by granting a variance upon a showing by the applicant or petitioner that the particular rule or regulation that is the subject of the variance request should not be applied as written because strict application would cause undue hardship. The applicant or petitioner additionally must show that adequate standards affording protection of health, safety, and care exist and will be met in lieu of the exact requirements of the rule or regulation in question;
   2. The department may dispense entirely with the enforcement of a rule or regulation by granting a waiver upon a showing by the applicant or petitioner that the purpose of the rule or regulation is met through equivalent standards affording equivalent protection of health, safety, and care;
   3. The department may grant waivers and variances to allow experimentation and demonstration of new and innovative approaches to delivery of services upon a showing by the applicant or petitioner that the intended protections afforded by the rule or regulation which is the subject of the request are met and that the innovative approach has the potential to improve service delivery;
   4. Waivers or variances which affect an entire class of facilities may only be approved by the Board of Public Health and shall be for a time certain, as determined by the board. A notice of the proposed variance or waiver affecting an entire class of facilities shall be made in accordance with the requirements for notice of rule making in Chapter 13 of Title 50, the "Georgia Administrative Procedure Act"; or
   5. Variances or waivers which affect only one facility in a class may be approved or denied by the department and shall be for a time certain, as determined by the department. The department shall maintain a record of such action and shall make this information available to the board and all other persons who request it.
3. The department may exempt classes of facilities from regulation when, in the department's judgment, regulation would not permit the purpose intended or the class of facilities is subject to similar requirements under other rules and regulations. Such exemptions shall be provided in rules and regulations promulgated by the board. (Code 1981, § 31-2A-6 , enacted by Ga. L. 2011, p. 705, § 3-1/HB 214.)

31-2A-7. "Conviction data" defined; department authorized to receive data from law enforcement relevant to employment decisions; criminal history information; retention of fingerprints.

1. As used in this Code section, the term "conviction data" means a record of a finding or verdict of guilty or a plea of guilty or a plea of nolo contendere with regard to any crime, regardless of whether an appeal of the conviction has been sought.
2. The department may receive from any law enforcement agency conviction data that is relevant to a person whom the department, its contractors, or a district or county health agency is considering as a final selectee for employment in a position the duties of which involve direct care, treatment, custodial responsibilities, or any combination thereof for its clients. The department may also receive conviction data which is relevant to a person whom the department, its contractors, or a district or county health agency is considering as a final selectee for employment in a position if, in the judgment of the department, a final employment decision regarding the selectee can only be made by a review of conviction data in relation to the particular duties of the position and the security and safety of clients, the general public, or other employees.
3. The department shall establish a uniform method of obtaining conviction data under subsection (b) of this Code section which shall be applicable to the department and its contractors. Such uniform method shall require the submission to the Georgia Crime Information Center of fingerprints and the records search fee in accordance with Code Section 35-3-35. Upon receipt thereof, the Georgia Crime Information Center shall promptly transmit fingerprints to the Federal Bureau of Investigation for a search of bureau records and an appropriate report and shall promptly conduct a search of its own records and records to which it has access. After receiving the fingerprints and fee, the Georgia Crime Information Center shall notify the department in writing of any derogatory finding, including, but not limited to, any conviction data regarding the fingerprint records check or if there is no such finding.
4. All conviction data received shall be for the exclusive purpose of making employment decisions or decisions concerning individuals in the care of the department and shall be privileged and shall not be released or otherwise disclosed to any other person or agency. Immediately following the employment decisions or upon receipt of the conviction data, all such conviction data collected by the department or its agent shall be maintained by the department or agent pursuant to laws regarding and the rules or regulations of the Federal Bureau of Investigation and the Georgia Crime Information Center, as is applicable. Penalties for the unauthorized release or disclosure of any conviction data shall be as prescribed pursuant to laws regarding and rules or regulations of the Federal Bureau of Investigation and the Georgia Crime Information Center, as is applicable. Nothing in this Code section shall be construed to allow criminal history information, including arrest and conviction data, to be released or disclosed to any individual, including members of county boards of health, who is not directly involved in the hiring process.
5. The department may promulgate written rules and regulations to implement the provisions of this Code section.
6. The department may receive from any law enforcement agency criminal history information, including arrest and conviction data, and any and all other information which it may be provided pursuant to state or federal law which is relevant to any person in the care of the department. The department shall establish a uniform method of obtaining criminal history information under this subsection. Such method shall require the submission to the Georgia Crime Information Center of fingerprints together with any required records search fee in accordance with Code Section 35-3-35. Upon receipt thereof, the Georgia Crime Information Center shall promptly transmit the fingerprints submitted by the department to the Federal Bureau of Investigation for a search of bureau records and an appropriate report and shall promptly conduct a search of its own records and records to which it has access. Such method shall also permit the submission of the names alone of such persons to the proper law enforcement agency for a name based check of such person's criminal history information as maintained by the Georgia Crime Information Center and the Federal Bureau of Investigation. In such circumstances, the department shall submit fingerprints of those persons together with any required records search fee to the Federal Bureau of Investigation within 15 calendar days of the date of the name based check on that person. The fingerprints shall be forwarded to the Federal Bureau of Investigation through the Georgia Crime Information Center in accordance with Code Section 35-3-35. Following the submission of such fingerprints, the department may receive the criminal history information, including arrest and conviction data, relevant to such person.
7. The department shall be authorized to conduct a name or descriptor based check of any person's criminal history information, including arrest and conviction data, and other information from the Georgia Crime Information Center regarding any adult person who provides care or is in contact with persons under the care of the department without the consent of such person and without fingerprint comparison to the fullest extent permissible by federal and state law.
8. If the department is participating in the program described in subparagraph (a)(1)(F) of Code Section 35-3-33 , the Georgia Bureau of Investigation and the Federal Bureau of Investigation shall be authorized to retain fingerprints obtained pursuant to this Code section for such program and the department shall notify the individual whose fingerprints were taken of the parameters of such retention. (Code 1981, § 31-2A-7 , enacted by Ga. L. 2011, p. 705, § 3-1/HB 214; Ga. L. 2018, p. 507, § 2-7/SB 336.)

The 2018 amendment, effective July 1, 2018, added subsection (h).

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2011, "data" was substituted for "date" in the last sentence of subsection (d).

Law reviews. - For article on the 2018 amendment of this Code section, see 35 Ga. St. U. L. Rev. 119 (2018).

31-2A-8. Department as agency of state for receipt and administration of federal and other funds.

The department is designated and empowered as the agency of this state to apply for, receive, and administer grants and donations for health purposes from the federal government and from any of its departments, agencies, and instrumentalities; from appropriations of the state; and from any other sources in conformity with law. The department shall have the authority to prescribe the purposes for which such funds may be used in order to:

1. Provide, extend, and improve maternal and child health services;
2. Locate children already disabled or suffering from conditions leading to a disability and provide for such children medical, surgical, corrective, and other services and to provide for facilities for diagnosis, hospitalization, and aftercare;
3. Advance the prevention and control of cancer and of sexually transmitted, tubercular, and other diseases;
4. Forestall and correct conditions that, if left to run their course, could be injurious to health;
5. Conduct programs which lie within the scope and the power of the department relating to industrial hygiene, control of ionizing radiation, occupational health, water quality, water pollution control, and planning and development of water resources;
6. Administer grants-in-aid to assist in the construction of publicly owned and operated general and special medical facilities;
7. Conduct programs:
   1. Relating to chronic illness;
   2. Relating to the dental and oral health of the people of this state which are appropriate to the purpose of the department; and
   3. Relating to the physical health of the people of this state which are appropriate to the purpose of the department; and
8. Develop the health aspects of emergency preparedness and emergency response. When a plan is required to be approved by any department, agency, or instrumentality of the federal government as condition precedent to the making of grants for health purposes, the department, as agent of this state, is directed to formulate, submit, and secure approval of that plan and thereafter, upon its approval and the receipt of funds payable thereunder, to carry the plan into effect in accordance with its terms, applying thereto the funds so received as well as other applicable amounts from whatever source. (Code 1933, § 88-111, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1972, p. 1069, § 3; Ga. L. 1978, p. 941, § 1; Code 1981, § 31-2-2 ; Code 1981, § 31-2-7 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228; Code 1981, § 31-2A-8 , as redesignated by Ga. L. 2011, p. 705, § 3-2/HB 214; Ga. L. 2020, p. 55, § 8/SB 372.)

The 2020 amendment, effective July 1, 2020, substituted "sexually transmitted" for "venereal" in paragraph (3).

31-2A-9. Studies and surveys of programs.

The department, from time to time, shall make or cause to be made studies and surveys to determine the quality, scope, and reach of its programs.

(Code 1933, § 88-109, enacted by Ga. L. 1964, p. 499, § 1; Code 1981, § 31-2-3 ; Code 1981, § 31-2-8 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228; Code 1981, § 31-2A-9 , as redesignated by Ga. L. 2011, p. 705, § 3-2/HB 214.)

31-2A-10. Venue of actions against department or board.

Actions at law and in equity against the department, the board, or any of its members predicated upon omissions or acts done in their official capacity or under color thereof shall be brought in the appropriate county; provided, however, that nothing in this Code section shall be construed as waiving the immunity of the state to be sued without its consent.

(Code 1933, § 88-118, enacted by Ga. L. 1964, p. 499, § 1; Code 1981, § 31-2-5 ; Ga. L. 1991, p. 94, § 31; Code 1981, § 31-2-10 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228; Code 1981, § 31-2A-10 , as redesignated by Ga. L. 2011, p. 705, § 3-2/HB 214.)

31-2A-11. Standards for sewage management systems.

1. As used in this Code section, the term:
   1. "Chamber system" means a system of chambers with each chamber being a molded polyolefin plastic, arch shaped, hollow structure with an exposed bottom area and solid top and louvered sidewall for infiltration of effluent into adjoining bottom and sidewall soil areas. Chambers may be of different sizes and configurations to obtain desired surface areas.
   2. "Conventional system" means a system traditionally used composed of perforated pipe surrounded by gravel or stone masking for the infiltration of effluent into adjoining bottom and side soil areas.
   3. "On-site sewage management system" means a sewage management system other than a public or community sewage treatment system serving one or more buildings, mobile homes, recreational vehicles, residences, or other facilities designed or used for human occupancy or congregation. Such term shall include, without limitation, conventional and chamber septic tank systems, privies, and experimental and alternative on-site sewage management systems which are designed to be physically incapable of a surface discharge of effluent that may be approved by the department.
   4. "Prior approved system" means only a chamber system or conventional system or component of such system which is designed to be physically incapable of a surface discharge of effluent and which was properly approved pursuant to subparagraph (a)(2)(B) of this Code section, as such Code section became law on April 19, 1994, for use according to manufacturers' recommendations, prior to April 14, 1997.
   5. "Unsatisfactory service" means documented substandard performance as compared to other approved systems or components.
2. The department shall have the authority as it deems necessary and proper to adopt state-wide regulations for on-site sewage management systems, including but not limited to experimental and alternative systems. The department is authorized to require that any such on-site sewage management system be examined and approved prior to allowing the use of such system in the state; provided, however, that any prior approved system shall continue to be approved for installation in every county of the state pursuant to the manufacturer's recommendations, including sizing of no less than 50 percent of trench length of a conventional system designed for equal flows in similar soil conditions. Upon written request of one-half or more of the health districts in the state, the department is authorized to require the reexamination of any such system or component thereof, provided that documentation is submitted indicating unsatisfactory service of such system or component thereof. Before any such examination or reexamination, the department may require the person, persons, or organization manufacturing or marketing the system to reimburse the department or its agent for the reasonable expenses of such examination.
3. 1. This subsection shall not be construed to prohibit the governing authority of any county or municipality in the state from adopting and enforcing codes at the local level; provided, however, that no county, municipality, or state agency may require any certified septic tank installer or certified septic tank pumper who has executed and deposited a bond as authorized in paragraph (2) of this subsection to give or furnish or execute any code compliance bond or similar bond for the purpose of ensuring that all construction, installation, or modifications are made or completed in compliance with the county or municipal ordinances or building and construction codes.
   2. In order to protect the public from damages arising from any work by a certified septic tank installer or certified septic tank pumper that fails to comply with any state construction codes or with the ordinances or building and construction codes adopted by any county or municipal corporation, any such certified septic tank installer or certified septic tank pumper may execute and deposit with the judge of the probate court in the county of his or her principal place of business a bond in the sum of $10,000.00. Such bond shall be a cash bond of $10,000.00 or executed by a surety authorized and qualified to write surety bonds in the State of Georgia and shall be approved by the local county or municipal health department. Such bond shall be conditioned upon all work done or supervised by such certificate holder complying with the provisions of any state construction codes or any ordinances or building and construction codes of any county or municipal corporation wherein the work is performed. Action on such bond may be brought against the principal and surety thereon in the name of and for the benefit of any person who suffers damages as a consequence of said certificate holder's work not conforming to the requirements of any ordinances or building and construction codes; provided, however, that the aggregate liability of the surety to all persons so damaged shall in no event exceed the sum of such bond.
   3. In any case where a bond is required under this subsection, the certified septic tank installer or certified septic tank pumper shall file a copy of the bond with the county or municipal health department in the political subdivision wherein the work is being performed.
   4. The provisions of this subsection shall not apply to or affect any bonding requirements involving contracts for public works as provided in Chapter 10 of Title 13.
4. This Code section does not restrict the work of a plumber licensed by the State Construction Industry Licensing Board to access any on-site sewage management system for the purpose of servicing or repairing any plumbing system or connection to the on-site sewage management system. (Code 1981, § 31-2-7 , enacted by Ga. L. 1992, p. 3308, § 1; Ga. L. 1994, p. 1777, § 1; Ga. L. 1997, p. 708, § 1; Ga. L. 2002, p. 850, § 1; Ga. L. 2006, p. 292, § 1/HB 724; Code 1981, § 31-2-12 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228; Code 1981, § 31-2A-11 , as redesignated by Ga. L. 2011, p. 705, § 3-2/HB 214.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1997, "April 14, 1997" was substituted for "the effective date of this Code section" at the end of paragraph (a)(4).

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-2A-12. Rules and regulations governing operation of land disposal sites for septic tank waste from one business.

Reserved. Repealed by Ga. L. 2012, p. 843, § 1B/HB 1102, effective July 1, 2014.

Editor's notes. - This Code section was based on Code 1981, § 31-2-8 , enacted by Ga. L. 2002, p. 927, § 6A; Ga. L. 2007, p. 127, § 5/HB 463; Code 1981, § 31-2-13 , as redesignated by Ga. L. 2009, p. 453, § 1-1/HB 228; Code 1981, § 31-2A-12 , as redesignated by Ga. L. 2011, p. 705, § 3-2/HB 214; Ga. L. 2012, p. 843, § 1B/HB 1102; Ga. L. 2016, p. 864, § 31/HB 737 and was repealed by its own terms effective July 1, 2014.

31-2A-13. Diabetes coordinator; central repository for data related to prevention and treatment of diabetes.

The commissioner is authorized to appoint a diabetes coordinator within the department to coordinate with other state departments and agencies to ensure that all programs that impact the prevention and treatment of diabetes are coordinated, that duplication of efforts is minimized, and that the impact of such programs is maximized in an attempt to reduce the health consequences and complications of diabetes in Georgia. The department shall serve as the central repository for this state's departments and agencies for data related to the prevention and treatment of diabetes.

(Code 1981, § 31-2-17 , enacted by Ga. L. 2009, p. 453, § 1-1/HB 228; Code 1981, § 31-2A-13 , as redesignated by Ga. L. 2011, p. 705, § 3-2/HB 214.)

Cross references. - Training school employees in caring for students with diabetes, § 20-2-779 .

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-2A-14. Georgia Diabetes Control Grant Program; advisory committee; administration of authorized grant programs; grant criteria.

1. There is established within the Department of Public Health the Georgia Diabetes Control Grant Program. The purpose of the grant program shall be to develop, implement, and promote a state-wide effort to combat the proliferation of Type 2 diabetes and pre-diabetes.
2. The program shall be under the direction of a seven-member advisory committee, appointed by the Governor. The Governor, in making such appointments, shall ensure to the greatest extent possible that the membership of the advisory committee is representative of this state's geographic and demographic composition, with appropriate attention to the representation of women, minorities, and rural Georgia. The appointments made by the Governor shall include one member who is:
   1. A physician licensed in this state;
   2. A registered nurse licensed in this state;
   3. A dietitian licensed in this state;
   4. A diabetes educator;
   5. A representative of the business community;
   6. A pharmacist licensed in this state; and
   7. A consumer who has diabetes.

      The commissioner, or his or her designee, shall serve as an ex officio, nonvoting member of the advisory committee. Appointed advisory committee members shall be named for five-year terms staggered so that one term will expire each year, except for the fourth and fifth year, when two terms will expire. Their successors shall be named for five-year terms.

3. The Georgia Diabetes Control Grant Program shall be authorized to administer two grant programs targeted at new, expanded, or innovative approaches to address diabetes as follows:
   1. A program to provide grants to middle schools and high schools to promote the understanding and prevention of diabetes may be established by the program. Such grants shall be provided through the appropriate local board of education. Grant requests shall contain specific information regarding requirements as to how the grant should be spent and how such spending promotes the understanding and prevention of diabetes. Grant recipients shall be required to provide the advisory committee with quarterly reports of the results of the grant program; and
   2. A program to provide grants to health care providers for support of evidence based diabetes programs for education, screening, disease management, and self-management targeting populations at greatest risk for pre-diabetes, diabetes, and the complications of diabetes; and grants may also be awarded to address evidence based activities that focus on policy, systems, and environmental changes that support prevention, early detection, and treatment of diabetes. Eligible entities shall include community and faith based clinics and other organizations, federally qualified health centers, regional and county health departments, hospitals, and other public entities, and other health related service providers which are qualified as exempt from taxation under the provisions of Section 501(c)(3) of the Internal Revenue Code of 1986. Such entities shall have been in existence for at least three years, demonstrate financial stability, utilize evidence based practices, and show measurable results in their programs.
4. The advisory committee shall work with the department to establish grant criteria and make award decisions, with the goal of creating a state-wide set of resources to assist residents of Georgia in their efforts to prevent or treat diabetes. Grants shall not be used for funding existing programs.
5. The grant program shall be under the direction of the diabetes coordinator appointed pursuant to Code Section 31-2A-13. The department shall provide sufficient staff, administrative support, and such other resources as may be necessary for the diabetes coordinator to carry out the duties required by this Code section.
6. This Code section shall be subject to appropriation from the General Assembly. (Code 1981, § 31-2-17.1 , enacted by Ga. L. 2010, p. 548, § 1-3/SB 435; Code 1981, § 31-2A-14 , as redesignated by Ga. L. 2011, p. 705, § 3-2/HB 214; Ga. L. 2011, p. 752, § 31/HB 142.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2010, "dietitian" was substituted for "dietician" in paragraph (b)(3).

Editor's notes. - Ga. L. 2010, p. 548, § 1-1/SB 435, not codified by the General Assembly, provides: "The General Assembly finds that:

"(1) Diabetes is a chronic disease caused by the inability of the pancreas to produce insulin or to use the insulin produced in the proper way;

"(2) If untreated and poorly managed, diabetes has been medically proven to lead to blindness, kidney failure, amputation, heart attack, and stroke;

"(3) Diabetes is the sixth leading cause of death in the United States, responsible for a similar number of deaths each year as HIV/AIDS;

"(4) In Georgia, the prevalence of diabetes is 8 percent higher than the nation as a whole;

"(5) One out of three people with diabetes are not aware that they have the disease;

"(6) Without aggressive societal action, the number of people living with diabetes in Georgia will more than double to 1,697,000 people in the next 20 years, cutting life short for these people by ten to 20 years; and

"(7) Without aggressive societal action, the economic burden of diabetes on the State of Georgia is expected to grow from $5 billion each year to about $11.9 billion in the next 20 years."

Ga. L. 2010, p. 548, § 1-2/SB 435, not codified by the General Assembly, provides: "This Act shall be known and may be cited as the 'Diabetes and Health Improvement Act of 2010.'"

Pursuant to the terms of subsection (f), funds were not appropriated at the 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017, 2018, 2019, or 2020 sessions of the General Assembly.

Ga. L. 2011, p. 752, § 54(e)/HB 142, not codified by the General Assembly, provides that: "In the event of an irreconcilable conflict between a provision in Sections 1 through 53 of this Act and a provision of another Act enacted at the 2011 regular session of the General Assembly, the provision of such other Act shall control over the conflicting provision in Sections 1 through 53 of this Act to the extent of the conflict." Accordingly, the amendment to subsection (b) of this Code section by Ga. L. 2011, p. 752, § 31(2)/HB 142, was not given effect.

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-2A-15. Additional duties of commissioner; authority to convene expert panels and consult with experts.

1. In addition to other authority and duties granted in this title, the commissioner shall:
   1. Provide a written report of expenditures made for public health purposes in the prior fiscal year to the Governor, the Speaker of the House of Representatives, and the Lieutenant Governor no later than December 1 of each year beginning December 1, 2010; and
   2. Serve as the chief liaison to county boards of health through their directors on matters related to the operations and programmatic responsibilities of such county boards of health; provided, however, the commissioner may designate a person from within the department to serve as such chief liaison.
2. The commissioner shall be authorized to convene one or more panels of experts to address various public health issues and may consult with experts on epidemiological and emergency preparedness issues. (Code 1981, § 31-2-18 , enacted by Ga. L. 2009, p. 453, § 1-1/HB 228; Code 1981, § 31-2A-15 , as redesignated by Ga. L. 2011, p. 705, § 3-2/HB 214.)

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-2A-16. Maternal Mortality Review Committee established.

1. The General Assembly finds that:
   1. Georgia currently ranks fiftieth in maternal deaths in the United States;
   2. Maternal deaths are a serious public health concern and have a tremendous family and societal impact;
   3. Maternal deaths are significantly underestimated and inadequately documented, preventing efforts to identify and reduce or eliminate the causes of death;
   4. No processes exist in this state for the confidential identification, investigation, or dissemination of findings regarding maternal deaths;
   5. The federal Centers for Disease Control and Prevention has determined that maternal deaths should be investigated through state based maternal mortality reviews in order to institute the systemic changes needed to decrease maternal mortality; and
   6. There is a need to establish a program to review maternal deaths and to develop strategies for the prevention of maternal deaths in Georgia.
2. The Department of Public Health shall establish a Maternal Mortality Review Committee to review maternal deaths and to develop strategies for the prevention of maternal deaths. The committee shall be multidisciplinary and composed of members as deemed appropriate by the department. The department may contract with an external organization to assist in collecting, analyzing, and disseminating maternal mortality information, organizing and convening meetings of the committee, and other tasks as may be incident to these activities, including providing the necessary data, information, and resources to ensure successful completion of the ongoing review required by this Code section.
3. The committee shall:
   1. Identify maternal death cases;
   2. Review medical records and other relevant data;
   3. Contact family members and other affected or involved persons to collect additional relevant data;
   4. Consult with relevant experts to evaluate the records and data;
   5. Make determinations regarding the preventability of maternal deaths;
   6. Develop recommendations for the prevention of maternal deaths; and
   7. Disseminate findings and recommendations to policy makers, health care providers, health care facilities, and the general public.
4. 1. Health care providers licensed pursuant to Title 43, health care facilities licensed pursuant to Chapter 7 of Title 31, and pharmacies licensed pursuant to Chapter 4 of Title 26 shall provide reasonable access to the committee to all relevant medical records associated with a case under review by the committee.
   2. A health care provider, health care facility, or pharmacy providing access to medical records pursuant to this Code section shall not be held liable for civil damages or be subject to any criminal or disciplinary action for good faith efforts in providing such records.
5. 1. Information, records, reports, statements, notes, memoranda, or other data collected pursuant to this Code section shall not be admissible as evidence in any action of any kind in any court or before any other tribunal, board, agency, or person. Such information, records, reports, statements, notes, memoranda, or other data shall not be exhibited nor their contents disclosed in any way, in whole or in part, by any officer or representative of the department or any other person, except as may be necessary for the purpose of furthering the review of the committee of the case to which they relate. No person participating in such review shall disclose, in any manner, the information so obtained except in strict conformity with such review project.
   2. All information, records of interviews, written reports, statements, notes, memoranda, or other data obtained by the department, the committee, and other persons, agencies, or organizations so authorized by the department pursuant to this Code section shall be confidential.
6. 1. All proceedings and activities of the committee under this Code section, opinions of members of such committee formed as a result of such proceedings and activities, and records obtained, created, or maintained pursuant to this Code section, including records of interviews, written reports, and statements procured by the department or any other person, agency, or organization acting jointly or under contract with the department in connection with the requirements of this Code section, shall be confidential and shall not be subject to Chapter 14 of Title 50, relating to open meetings, or Article 4 of Chapter 18 of Title 50, relating to open records, or subject to subpoena, discovery, or introduction into evidence in any civil or criminal proceeding; provided, however, that nothing in this Code section shall be construed to limit or restrict the right to discover or use in any civil or criminal proceeding anything that is available from another source and entirely independent of the committee's proceedings.
   2. Members of the committee shall not be questioned in any civil or criminal proceeding regarding the information presented in or opinions formed as a result of a meeting or communication of the committee; provided, however, that nothing in this Code section shall be construed to prevent a member of the committee from testifying to information obtained independently of the committee or which is public information.
7. Reports of aggregated nonindividually identifiable data shall be compiled on a routine basis for distribution in an effort to further study the causes and problems associated with maternal deaths. A detailed annual report shall be submitted no later than October 1 to the Office of Health Strategy and Coordination. (Code 1981, § 31-2A-16 , enacted by Ga. L. 2014, p. 337, § 1/SB 273; Ga. L. 2019, p. 148, § 2-6/HB 186.)

The 2019 amendment, effective July 1, 2019, substituted the present provisions of the second sentence of subsection (g) for the former provisions, which read: "Reports shall be distributed to the General Assembly, health care providers and facilities, key government agencies, and others necessary to reduce the maternal death rate".

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2014, Code Section 31-2A-16, as enacted by Ga. L. 2014, p. 822, § 1/HB 966, was redesignated as Code Section 31-2A-17.

Editor's notes. - Ga. L. 2019, p. 148, § 2-1/HB 186, not codified by the General Assembly, provides: "This part shall be known and may be cited as 'The Health Act.' "

Law reviews. - For annual survey on administrative law, see 66 Mercer L. Rev. 1 (2014).

31-2A-17. Alzheimer's Disease Registry established; purpose; procedures; rules and regulations; confidentiality of data.

1. There is established within the Department of Public Health the Alzheimer's Disease Registry.
2. The purpose of the registry shall be to assist in the development of public policy and planning relative to Alzheimer's disease and related disorders. The registry shall provide a central data base of individuals with Alzheimer's disease or related disorders.
3. The department shall establish procedures and promulgate rules and regulations for the establishment and operation of the registry. Such procedures, rules, and regulations shall provide for:
   1. Collecting and evaluating data regarding the prevalence of Alzheimer's disease and related disorders in Georgia, including who shall report the data to the registry;
   2. Determining what information shall be maintained in the registry and the length of time such data shall be available;
   3. Sharing of data for policy planning purposes;
   4. Disclosing nonidentifying data to support Alzheimer's and related disorder research;
   5. The methodology by which families and physicians of persons who are reported to the registry shall be contacted to gather additional data; and
   6. Information about public and private resources.
4. The collected data in the registry shall be confidential, and all persons to whom the data is released shall maintain patient confidentiality. No publication of information, biotechnical research, or medical data shall be made that identifies any patient by name. The registry shall be established and regulated pursuant to the requirements of 42 U.S.C. Section 1301, et seq., and P.L. 104-191, the federal Health Insurance Portability and Accountability Act of 1996. (Code 1981, § 31-2A-17 , enacted by Ga. L. 2014, p. 822, § 1/HB 966.)

Cross references. - Alzheimer's and Related Dementias State Plan, T. 49, C. 6, Art. 8.

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2014, Code Section 31-2A-16, as enacted by Ga. L. 2014, p. 822, § 1/HB 966, was redesignated as Code Section 31-2A-17.

Law reviews. - For annual survey on administrative law, see 66 Mercer L. Rev. 1 (2014). For article on the 2014 enactment of this Code section, see 31 Ga. St. U. L. Rev. 129 (2014).

31-2A-18. Establishment of the Low THC Oil Patient Registry; definitions; purpose; registration cards; semiannual reports; waiver forms; annual review and recommendations.

1. As used in this Code section, the term:
   1. "Board" means the Georgia Composite Medical Board.
   2. "Caregiver" means the parent, guardian, or legal custodian of an individual who is less than 18 years of age or the legal guardian of an adult.
   3. "Condition" means:
      1. Cancer, when such disease is diagnosed as end stage or the treatment produces related wasting illness or recalcitrant nausea and vomiting;
      2. Amyotrophic lateral sclerosis, when such disease is diagnosed as severe or end stage;
      3. Seizure disorders related to a diagnosis of epilepsy or trauma related head injuries;
      4. Multiple sclerosis, when such disease is diagnosed as severe or end stage;
      5. Crohn's disease;
      6. Mitochondrial disease;
      7. Parkinson's disease, when such disease is diagnosed as severe or end stage;
      8. Sickle cell disease, when such disease is diagnosed as severe or end stage;
      9. Tourette's syndrome, when such syndrome is diagnosed as severe;
      10. Autism spectrum disorder, when such disorder is diagnosed for a patient who is at least 18 years of age, or severe autism, when diagnosed for a patient who is less than 18 years of age;
      11. Epidermolysis bullosa;
      12. Alzheimer's disease, when such disease is diagnosed as severe or end stage;
      13. Acquired immune deficiency syndrome, when such syndrome is diagnosed as severe or end stage;
      14. Peripheral neuropathy, when such symptoms are diagnosed as severe or end stage;
      15. Post-traumatic stress disorder resulting from direct exposure to or the witnessing of a trauma for a patient who is at least 18 years of age; or
      16. Intractable pain.
   4. "Department" means the Department of Public Health.
   5. "Intractable pain" means pain that has a cause that cannot be removed and for which, according to generally accepted medical practice, the full range of pain management modalities appropriate for the patient has been used for a period of at least six months without adequate results or with intolerable side effects.
   6. "Low THC oil" shall have the same meaning as set forth in Code Section 16-12-190.
   7. "Physician" means an individual licensed to practice medicine pursuant to Article 2 of Chapter 34 of Title 43.
   8. "Registry" means the Low THC Oil Patient Registry.
2. There is established within the department the Low THC Oil Patient Registry.
3. The purpose of the registry is to provide a registration of individuals and caregivers who have been issued registration cards. The department shall establish procedures and promulgate rules and regulations for the establishment and operation of the registration process and dispensing of registry cards to individuals and caregivers.
4. The department shall issue a registration card to individuals who have been certified to the department by his or her physician as being diagnosed with a condition or is an inpatient or outpatient in a hospice program and have been authorized by such physician to use low THC oil as treatment. The department shall issue a registration card to a caregiver when the circumstances warrant the issuance of such card.  The board shall establish procedures and promulgate rules and regulations to assist physicians in providing required uniform information relating to certification and any other matter relating to the issuance of certifications.  In promulgating such rules and regulations, the board shall require that physicians have a doctor-patient relationship when certifying an individual as needing low THC oil and physicians shall be required to be treating such individual for the specific condition requiring such treatment or be treating such individual in a hospice program.  A physician shall seek and review information about a patient from the prescription drug monitoring program data base established pursuant to Code Section 16-13-57 prior to certifying such patient to the department as being diagnosed with a specific condition that requires the use of low THC oil as treatment.
5. The board shall require physicians to issue semiannual reports to the board.  Such reports shall require physicians to provide information, including, but not limited to, dosages recommended for a particular condition, patient clinical responses, levels of tetrahydrocannabinol or tetrahydrocannabinolic acid present in test results, compliance, responses to treatment, side effects, and drug interactions.  Such reports shall be used for research purposes to determine the efficacy of the use of low THC oil as a treatment for conditions.
6. Information received and records kept by the department for purposes of administering this Code section shall be confidential; provided, however, that such information shall be disclosed:
   1. Upon written request of an individual or caregiver registered pursuant to this Code section; and
   2. To peace officers and prosecuting attorneys for the purpose of:
      1. Verifying that an individual in possession of a registration card is registered pursuant to this Code section; or
      2. Determining that an individual in possession of low THC oil is registered pursuant to this Code section.
7. The board shall develop a waiver form that will advise that the use of cannabinoids and THC containing products have not been approved by the FDA and the clinical benefits are unknown and may cause harm. Any patient or caregiver shall sign such waiver prior to his or her approval for registration.
8. The board, in coordination with the Department of Public Health, shall annually review the conditions included in paragraph (3) of subsection (a) of this Code section and recommend additional conditions that have been shown through medical research to be effectively treated with low THC oil. Such recommendations shall include recommended dosages for a particular condition, patient responses to treatment with respect to the particular condition, and drug interactions with other drugs commonly taken by patients with the particular condition.  Such recommendations shall be made jointly by the board and the Department of Public Health to the General Assembly no later than December 1 of each year. (Code 1981, § 31-2A-18 , enacted by Ga. L. 2015, p. 49, § 2-1/HB 1; Ga. L. 2017, p. 611, § 2/SB 16; Ga. L. 2017, p. 774, § 31/HB 323; Ga. L. 2018, p. 148, § 2/HB 65; Ga. L. 2019, p. 43, § 6/HB 324.)

The 2017 amendments. The first 2017 amendment, effective July 1, 2017, substituted "disease is diagnosed as" for "diagnosis is" throughout paragraph (a)(3); substituted "illness or" for "illness," in subparagraph (a)(3)(A); inserted "a" in subparagraph (a)(3)(C); deleted "or" at the end of subparagraph (a)(3)(G); substituted a semicolon for a period at the end of subparagraph (a)(3)(H); added subparagraphs (a)(3)(I) through (a)(3)(N); deleted the former third and fourth sentences in subsection (c), which read: "Only individuals residing in this state for at least one year or a child born in this state less than one year old shall be eligible for registration under this Code section. Nothing in this Code section shall apply to any Georgia residents living temporarily in another state for the purpose of securing THC oil for treatment of any condition under this Code section."; in subsection (d), in the first sentence, substituted "individuals who have" for "individuals and caregivers as soon as practicable but no later than September 1, 2015, when an individual has" near the beginning, inserted "or is an inpatient or outpatient in a hospice program", substituted "have been authorized" for "has been authorized" near the middle, and deleted "for such condition" following "as treatment" at the end, added the second sentence, and, in the fourth sentence, substituted "treating such individual" for "treating an individual" near the middle, and added "or be treating such individual in a hospice program" at the end; in subsection (e), substituted "semiannual" for "quarterly" in the first sentence, in the second sentence, inserted "patient" and inserted "levels of tetrahydrocannabinol or tetrahydrocannabinolic acid present in test results,". The second 2017 amendment, effective May 9, 2017, part of an Act to revise, modernize, and correct the Code, revised punctuation in subparagraph (a)(3)(A).

The 2018 amendment, effective July 1, 2018, in subsection (a), deleted "or" at the end of subparagraph (a)(3)(M), substituted a semicolon for a period at the end of subparagraph (a)(3)(N), added subparagraphs (a)(3)(O) and (a)(3)(P), added paragraph (a)(5), redesignated former paragraphs (a)(5) through (a)(7) as present paragraphs (a)(6) through (a)(8), respectively; and added subsection (h).

The 2019 amendment, effective July 1, 2019, added the last sentence in subsection (d); added the last sentence in subsection (e); and, in subsection (h), inserted ", in coordination with the Department of Public Health," near the beginning of the first sentence and inserted "jointly by the board and the Department of Public Health" in the middle of the last sentence.

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2017, a comma was deleted following "nausea" in subparagraph (a)(3)(A).

Editor's notes. - Ga. L. 2015, p. 49, § 1-1/HB 1, not codified by the General Assembly, provides that: "This Act shall be known and may be cited as the 'Haleigh's Hope Act.'"

Ga. L. 2019, p. 43, § 1/HB 324, not codified by the General Assembly, provides that: "This Act shall be known and may be cited as 'Georgia's Hope Act.'"

Ga. L. 2019, p. 43, § 2/HB 324, not codified by the General Assembly, provides that: "(a) The General Assembly finds that the establishment of the Low THC Oil Patient Registry in 2015 allows Georgia patients to possess low THC oil but provides no way to access low THC oil. The General Assembly finds that thousands of Georgians have serious medical conditions that can be improved by the medically approved use of cannabis and that the law should not stand between them and treatment necessary for life and health. The General Assembly finds that the purpose of this Act is to allow the legitimate use of medical cannabis for health care, including palliative care. The General Assembly finds that this Act does not in any way diminish this state's strong public policy and laws against illegal drug use, nor should it be deemed in any manner to advocate, authorize, promote, or legally or socially accept the use of marijuana for children or adults for any nonmedical use.

"(b) The General Assembly further finds that:

"(1) Low THC oil can offer significant medical benefits to patients;

"(2) Low THC oil can only be derived from the cannabis plant;

"(3) A carefully constructed system of in-state cultivation to benefit only those patients authorized by Georgia law and approved by their physician would benefit patients within the State of Georgia;

"(4) The State of Georgia is deeply opposed to any recreational or nonmedical use of marijuana, and any system to help patients access low THC oil should be as limited in scope as possible;

"(5) Business opportunities resulting from a system of in-state cultivation should be inclusive of minority, women, and veteran owned businesses;

"(6) Businesses resulting from this Act should include at least 20 percent participation by minority, women, and veteran owned businesses as licensees, suppliers, and partners of businesses licensed under this Act; and

"(7) The State of Georgia should encourage active participation by minority, women, and veteran owned businesses, as well as take any steps necessary to ensure there is no discrimination in the issuance of licenses or participation in business activities resulting from this Act."

Law reviews. - For article on the 2015 enactment of this Code section, see 32 Ga. St. U. L. Rev. 153 (2015). For article on the 2019 amendment of this Code section, see 36 Ga. St. U.L. Rev. 39 (2019).

31-2A-19. Creation of Joint Study Commission on Low THC Medical Oil Access; membership; operation; reporting; abolishment.

Reserved. Repealed by Ga. L. 2018, p. 148, § 1/HB 65, effective December 31, 2018.

Editor's notes. - This Code section was based on Code 1981, § 31-2A-19 , enacted by Ga. L. 2018, p. 148, § 1/HB 65.

31-2A-30. Legislative authority.

Reserved. Repealed by Ga. L. 2017, p. 764, § 2-1/SB 193, effective July 1, 2017.

Editor's notes. - This Code section was based on Ga. L. 2016, p. 214, § 2/SB 308.

Ga. L. 2017, p. 764, § 1-1/SB 193, not codified by the General Assembly, provides that: "The General Assembly finds that:

"(1) Untreated chlamydial infection has been linked to problems during pregnancy, including preterm labor, premature rupture of membranes, and low birth weight. The newborn may also become infected during delivery as the baby passes through the birth canal. Exposed newborns can develop eye and lung infections; and

"(2) Untreated gonococcal infection in pregnancy has been linked to miscarriages, premature birth and low birth weight, premature rupture of membranes, and chorioamnionitis. Gonorrhea can also infect an infant during delivery as the infant passes through the birth canal. If untreated, infants can develop eye infections."

31-2A-31. Definitions.

As used in this article, the term:

1. "Attending physician" means the physician who has primary responsibility at the time of reference for the treatment and care of the client.
2. "Client" means a person seeking or receiving pregnancy support services.
3. "Contract management agency" or "agency" means a nongovernmental charitable organization in this state which is a 501(c)(3) tax-exempt organization under the Internal Revenue Code of 1986 and whose mission and practice is to promote alternatives to abortion services at no cost.
4. "Direct client service providers" or "providers" means nonprofit organizations with a contractual relationship with the contract management agency and that provide direct pregnancy support services to clients at no cost.
5. Reserved.
6. "Pregnancy support services" means those services that encourage childbirth instead of voluntary termination of pregnancy and which assist pregnant women or women who believe they may be pregnant to choose childbirth whether they intend to parent or select adoption for the child.
7. "Program" means the Positive Alternatives for Pregnancy and Parenting Grant Program. (Code 1981, § 31-2A-31 , enacted by Ga. L. 2016, p. 214, § 2/SB 308; Ga. L. 2017, p. 764, § 2-2/SB 193; Ga. L. 2018, p. 1112, § 31/SB 365.)

The 2017 amendment, effective July 1, 2017, near the end of paragraph (3), substituted "promote" for "provide" and deleted "to medically indigent women" following "services" near the end; substituted the present provisions of paragraph (5) for the former provisions, which read: "'Medically indigent' means a person who is without health insurance or who has health insurance that does not cover pregnancy or related conditions for which treatment and services are sought and whose family income does not exceed 200 percent of the federal poverty level as defined annually by the federal Office of Management and Budget."; and substituted the present provisions of paragraph (8) for the former provisions, which read: "'Trust fund' means the Indigent Care Trust Fund created by Code Section 31-8-152.".

The 2018 amendment, effective May 8, 2018, part of an Act to revise, modernize, and correct the Code, repealed the reservation of paragraph (8).

Editor's notes. - Ga. L. 2017, p. 764, § 1-1/SB 193, not codified by the General Assembly, provides that: "The General Assembly finds that:

"(1) Untreated chlamydial infection has been linked to problems during pregnancy, including preterm labor, premature rupture of membranes, and low birth weight. The newborn may also become infected during delivery as the baby passes through the birth canal. Exposed newborns can develop eye and lung infections; and

"(2) Untreated gonococcal infection in pregnancy has been linked to miscarriages, premature birth and low birth weight, premature rupture of membranes, and chorioamnionitis. Gonorrhea can also infect an infant during delivery as the infant passes through the birth canal. If untreated, infants can develop eye infections."

31-2A-32. Positive Alternatives for Pregnancy and Parenting Grant Program.

There is established within the department the Positive Alternatives for Pregnancy and Parenting Grant Program. The purpose of the program shall be to develop a state-wide effort that promotes healthy pregnancies and childbirth by awarding grants to nonprofit organizations that provide pregnancy support services.

(Code 1981, § 31-2A-32 , enacted by Ga. L. 2016, p. 214, § 2/SB 308; Ga. L. 2017, p. 764, § 2-3/SB 193; Ga. L. 2017, p. 774, § 31/HB 323.)

The 2017 amendments. The first 2017 amendment, effective July 1, 2017, in the second sentence, deleted "grant" preceding "program" and substituted "develop a state-wide effort that promotes healthy pregnancies and childbirth" for "promote healthy pregnancies and childbirth". The second 2017 amendment, effective May 9, 2017, part of an Act to revise, modernize, and correct the Code, deleted "grant" preceding "program" at the beginning of the second sentence.

Editor's notes. - Ga. L. 2017, p. 764, § 1-1/SB 193, not codified by the General Assembly, provides that: "The General Assembly finds that:

"(1) Untreated chlamydial infection has been linked to problems during pregnancy, including preterm labor, premature rupture of membranes, and low birth weight. The newborn may also become infected during delivery as the baby passes through the birth canal. Exposed newborns can develop eye and lung infections; and

"(2) Untreated gonococcal infection in pregnancy has been linked to miscarriages, premature birth and low birth weight, premature rupture of membranes, and chorioamnionitis. Gonorrhea can also infect an infant during delivery as the infant passes through the birth canal. If untreated, infants can develop eye infections."

31-2A-33. Administration and duties.

1. The department shall oversee the program and is authorized to contract with a contract management agency to administer the program.
2. The contract management agency selected by the department shall meet the definition of a contract management agency as defined in paragraph (3) of Code Section 31-2A-31 and shall:
   1. Create a grant application process;
   2. Evaluate grant applications and make recommendations to the department;
   3. Communicate acceptance or denial of grant applications to direct client service providers;
   4. Monitor compliance with the terms and conditions of the grant;
   5. Maintain records for each grant applicant and award; and
   6. Coordinate activities and correspondence between the department and direct client service providers. (Code 1981, § 31-2A-33 , enacted by Ga. L. 2016, p. 214, § 2/SB 308; Ga. L. 2017, p. 764, § 2-4/SB 193.)

The 2017 amendment, effective July 1, 2017, added "meet the definition of a contract management agency as defined in paragraph (3) of Code Section 31-2A-31 and shall" at the end of subsection (b).

Editor's notes. - Ga. L. 2017, p. 764, § 1-1/SB 193, not codified by the General Assembly, provides that: "The General Assembly finds that:

"(1) Untreated chlamydial infection has been linked to problems during pregnancy, including preterm labor, premature rupture of membranes, and low birth weight. The newborn may also become infected during delivery as the baby passes through the birth canal. Exposed newborns can develop eye and lung infections; and

"(2) Untreated gonococcal infection in pregnancy has been linked to miscarriages, premature birth and low birth weight, premature rupture of membranes, and chorioamnionitis. Gonorrhea can also infect an infant during delivery as the infant passes through the birth canal. If untreated, infants can develop eye infections."

31-2A-34. Services funded by program.

The services which shall be funded by the program include:

1. Medical care and information, including but not limited to pregnancy tests, sexually transmitted infection tests, other health screenings, ultrasound service, prenatal care, and birth classes and planning;
2. Nutritional services and education;
3. Housing, education, and employment assistance during pregnancy and up to one year following a birth;
4. Adoption education, planning, and services;
5. Child care assistance if necessary for the client to receive pregnancy support services;
6. Parenting education and support services for up to one year following a birth;
7. Material items which are supportive of pregnancy and childbirth, including but not limited to cribs, car seats, clothing, formula, or other safety devices; and
8. Information regarding health care benefits, including but not limited to available Medicaid coverage for the client for pregnancy care that provides health coverage for the client's child upon his or her birth. (Code 1981, § 31-2A-34 , enacted by Ga. L. 2016, p. 214, § 2/SB 308; Ga. L. 2017, p. 774, § 31/HB 323.)

The 2017 amendment, effective May 9, 2017, part of an Act to revise, modernize, and correct the Code, revised language and punctuation throughout this Code section.

31-2A-35. Grants.

1. Grants shall be awarded annually on a competitive basis to direct client service providers who display competent experience in providing any of the services included in Code Section 31-2A-34 pursuant to guidelines and criteria established pursuant to this article.
2. The department shall, with input from the agency, determine the maximum grant amount to be awarded to each direct client service provider, and such grant amount shall not exceed 85 percent of the annual revenue for the prior year of any provider.
3. The grant agreement entered into between the agency and a direct client service provider shall stipulate that the grant shall be used to provide any or all pregnancy support services at the discretion of the service provider pursuant to Code Section 31-2A-34 . The agreement shall further stipulate that a direct client service provider shall not perform, promote, or act as a referral for an abortion, except as otherwise provided in paragraph (9) of subsection (a) of Code Section 31-2A-36 , and that grant funds shall not be used to promote or be otherwise expended for political or religious purposes, including, but not limited to, counseling or written material. Nothing in this article shall be construed to prohibit any direct client service provider from promoting or expending nongrant funds for a political or religious purpose. (Code 1981, § 31-2A-35 , enacted by Ga. L. 2016, p. 214, § 2/SB 308; Ga. L. 2017, p. 764, § 2-5/SB 193.)

The 2017 amendment, effective July 1, 2017, inserted "any of" in the middle of subsection (a); and, in subsection (c), in the first sentence, inserted "any or all" and inserted "at the discretion of the service provider", and added the third sentence.

Editor's notes. - Ga. L. 2017, p. 764, § 1-1/SB 193, not codified by the General Assembly, provides that: "The General Assembly finds that:

"(1) Untreated chlamydial infection has been linked to problems during pregnancy, including preterm labor, premature rupture of membranes, and low birth weight. The newborn may also become infected during delivery as the baby passes through the birth canal. Exposed newborns can develop eye and lung infections; and

"(2) Untreated gonococcal infection in pregnancy has been linked to miscarriages, premature birth and low birth weight, premature rupture of membranes, and chorioamnionitis. Gonorrhea can also infect an infant during delivery as the infant passes through the birth canal. If untreated, infants can develop eye infections."

31-2A-36. Criteria for grant consideration.

1. In order to be considered for a grant under this article, each direct client service provider shall:
   1. Be a nonprofit organization incorporated in this state with a tax-exempt status pursuant to Section 501(c)(3) of the Internal Revenue Code of 1986;
   2. Have a primary mission of promoting healthy pregnancy and childbirth;
   3. Have a system of financial accountability consistent with generally accepted accounting principles, including an annual budget;
   4. Have a board that hires and supervises a director who manages the organization's operations;
   5. Have provided pregnancy support services for a minimum of one year;
   6. Offer, at a minimum, pregnancy tests and counseling for women who are or may be experiencing unplanned pregnancies;
   7. Provide confidential and free pregnancy support services;
   8. Provide each pregnant client with accurate information on the developmental characteristics of babies and of unborn children, including offering the printed materials described in Code Section 31-9A-4 on fetal development and assistance available following a birth;
   9. Ensure that grant money is not used to encourage or affirmatively counsel a client to have an abortion unless the client's attending physician diagnoses a condition which makes such abortion necessary to prevent her death; to provide her an abortion; or to directly refer her to an abortion provider for an abortion; and
   10. Maintain confidentiality of all data, files, and records of clients related to the services provided and in compliance with state and federal laws.
2. The department shall publish the direct client service provider criteria on its website. (Code 1981, § 31-2A-36 , enacted by Ga. L. 2016, p. 214, § 2/SB 308.)

31-2A-37. Record maintenance and reporting.

Each direct client service provider shall maintain accurate records and report data to the agency annually on forms and in the manner required by the department. Reports shall include the number of clients who:

1. Utilized pregnancy support services;
2. Are pregnant;
3. Chose childbirth after receiving pregnancy support services;
4. Chose adoption after receiving pregnancy support services; and
5. Chose abortion after receiving pregnancy support services. Each provider may be required to provide other information and data at the discretion of the department. (Code 1981, § 31-2A-37 , enacted by Ga. L. 2016, p. 214, § 2/SB 308.)

31-2A-38. Confidentiality.

Confidentiality of all data, files, and records of clients related to the services provided under this article shall be maintained by the department, contract management agency, and direct client service providers pursuant to federal and state laws related to privacy of medical records, including requirements under the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191.

(Code 1981, § 31-2A-38 , enacted by Ga. L. 2016, p. 214, § 2/SB 308.)

31-2A-39. Annual audit.

The agency shall conduct an annual audit of each direct client service provider by an independent certified public accountant within 120 days of the completion of its fiscal year verifying that it has complied with all requirements of this article and any other requirements of the department.

(Code 1981, § 31-2A-39 , enacted by Ga. L. 2016, p. 214, § 2/SB 308.)

31-2A-40. Reports to the General Assembly.

1. The department shall annually report to the General Assembly on its use of trust funds appropriated to the department pursuant to this article.
2. The department shall also provide an annual report no later than September 30 of each year beginning September 30, 2017, which shall provide the following information for the immediately preceding fiscal year:
   1. The amount of any contributions or other funding received;
   2. The total amount of expenses; and
   3. The amount of trust funds disbursed through the agency to direct client service providers.
3. The reports required by this Code section shall be made available to the public free of charge by electronic means and in such other manner as the department deems appropriate. (Code 1981, § 31-2A-40 , enacted by Ga. L. 2016, p. 214, § 2/SB 308.)

31-2A-41. Acceptance of donations, contributions, and gifts.

The department is authorized to accept donations, contributions, and gifts and receive, hold, and use grants, devises, and bequests of real, personal, and mixed property on behalf of the state to enable the department to carry out the functions and purposes of this article.

(Code 1981, § 31-2A-41 , enacted by Ga. L. 2016, p. 214, § 2/SB 308.)

31-2A-50. Legislative findings.

The General Assembly finds and declares that:

1. Georgia ranks as the forty-ninth worst in the nation for the number of maternal deaths occurring during and one year after pregnancy;
2. Georgia ranks as the thirty-second worst in the nation for the number of infant deaths occurring before the first birthday;
3. Georgia ranks as the forty-fifth worst in the nation for the percentage of premature births, a leading cause of infant deaths;
4. Low birth weight or premature infants are more likely to survive if the birth takes place in a facility which is prepared to handle the risks associated with such deliveries;
5. Several states have established programs to inspect and designate facilities that have developed the capacity to provide expanded levels of neonatal and maternal care; and
6. Therefore, it is in the best interest of the residents of this state to establish a program that encourages the improvement of quality of care to create better maternal and neonatal outcomes. (Code 1981, § 31-2A-50 , enacted by Ga. L. 2018, p. 344, § 1/HB 909; Ga. L. 2019, p. 1056, § 31/SB 52.)

The 2019 amendment, effective May 12, 2019, part of an Act to revise, modernize, and correct the Code, revised language in paragraph (1).

31-2A-51. Definitions.

As used in this article, the term:

1. "Designated facility" means a perinatal facility that has been inspected and approved by the department pursuant to this article as meeting its established criteria for a particular maternal or neonatal level of care.
2. "Perinatal facility" means a hospital, clinic, or birthing center that provides maternal or neonatal health care services. (Code 1981, § 31-2A-51 , enacted by Ga. L. 2018, p. 344, § 1/HB 909.)

31-2A-52. Approval as designated perinatal facility; establishing criteria for levels of maternal and neonatal care.

1. The department shall establish a procedure by which a perinatal facility may request approval as a designated facility which has achieved a particular maternal or neonatal level of care.
2. 1. The department shall establish through rule making the criteria for levels of maternal and neonatal care, ranging from basic care to such additional levels of care as may be deemed appropriate for the protection of mothers and infants at elevated risk.
   2. The department shall establish separate criteria for levels of maternal care and neonatal care. Such criteria may include, without limitation, data collection and reporting, arrangements for patient transportation, and protocols for coordination with and referral of patients to and from other health care facilities.
   3. In establishing or revising the criteria for maternal and neonatal levels of care, the department shall conduct public comment hearings; solicit the views of hospitals, birthing centers, health care providers, and related professional associations; and give due consideration to the current recommendations of medical and scientific organizations in the field of perinatal medicine. (Code 1981, § 31-2A-52 , enacted by Ga. L. 2018, p. 344, § 1/HB 909; Ga. L. 2019, p. 1056, § 31/SB 52.)

The 2019 amendment, effective May 12, 2019, part of an Act to revise, modernize, and correct the Code, revised language in paragraph (b)(1).

31-2A-53. Application process; review and redesignation of facilities; failure to comply with criteria.

1. A perinatal facility may apply to the department for designation through an application process to be determined by the department. The facility shall demonstrate to the satisfaction of the department that it meets the applicable criteria for the requested level of care. The application process may include an on-site inspection of the facility at the discretion of the department.
2. The department may establish requirements for the periodic review and redesignation of designated facilities.
3. The department may suspend or revoke the designation of a designated facility, after notice and hearing, if the department determines that the facility is no longer in compliance with the criteria established pursuant to this article. (Code 1981, § 31-2A-53 , enacted by Ga. L. 2018, p. 344, § 1/HB 909.)

31-2A-54. Listing of designated facilities; self-assessment tool.

1. On or before December 31, 2019, the department shall post and annually update a list of designated facilities on its website.
2. The department shall adopt or develop a self-assessment tool for use by perinatal facilities that includes separate, minimum requirements for neonatal and maternal levels of care. The department shall post this assessment tool on its website no later than July 1, 2019. (Code 1981, § 31-2A-54 , enacted by Ga. L. 2018, p. 344, § 1/HB 909.)

31-2A-55. Provisions are not medical care; individualized care and treatment.

This article, and any criteria developed by the department pursuant to this article, shall not be construed to be a medical practice guideline or to establish a standard of care for treatment and shall not be used to restrict or expand the authority of a hospital or other health care facility to provide services for which it has received a license under state law. The General Assembly intends that all patients be treated individually based on each patient's needs and circumstances.

(Code 1981, § 31-2A-55 , enacted by Ga. L. 2018, p. 344, § 1/HB 909.)

31-2A-56. Advertisement prohibited unless designated by department.

No person or facility may advertise to the public, by way of any medium whatsoever, that it is a designated facility or has achieved a particular level of maternal or neonatal care according to the criteria established pursuant to this article, unless it has been designated as such by the department.

(Code 1981, § 31-2A-56 , enacted by Ga. L. 2018, p. 344, § 1/HB 909.)

31-2A-57. Regulatory authority.

The department shall be authorized to promulgate rules and regulations to carry out the purposes of this article.

(Code 1981, § 31-2A-57 , enacted by Ga. L. 2018, p. 344, § 1/HB 909.)

31-3-1. Creation.

There is established a county board of health in each and every county of this state.

(Ga. L. 1914, p. 124, § 2; Code 1933, § 88-201; Ga. L. 1941, p. 317, § 1; Ga. L. 1964, p. 499, § 1.)

31-3-2. Composition; terms of members.

1. Each county board of health shall be composed of seven members as follows:
   1. One member shall be the chief executive officer of the governing authority of the county, by whatever name called, or some member designated by said officer; in counties where the governing authority is the judge of the probate court of the county, he shall be the member so appointed;
   2. One member shall be the county superintendent of schools or other school personnel may be designated by said superintendent for such time period as determined by the superintendent but not to exceed such superintendent's contract term;
   3. Except as otherwise provided in this paragraph, one member to be appointed by the governing authority of the county shall be a physician actively practicing medicine in the county and licensed under Chapter 34 of Title 43. If there are fewer than four physicians actively practicing in the county or if there is no physician actively practicing in the county who is willing and able to serve, the governing authority may appoint a person licensed as a nurse or dentist under Chapter 26 or 11, respectively, of Title 43, and actively practicing such profession in the county or any other person having a familiarity with and concern for the provision of medical services in the county;
   4. One member to be appointed by the governing authority of the county shall be a consumer, a representative of a consumer, or a person from an advocacy agency or group, which member will represent on the board the county's consumers of health services;
   5. One member to be appointed by the governing authority of the largest municipality in the county shall be a person interested in promoting public health who is a consumer or a nurse licensed under Chapter 26 of Title 43;
   6. One member to be appointed by the governing authority of the county shall be a consumer member who will represent on the board the county's needy, underprivileged, or elderly community; and
   7. One member shall be the chief executive officer of the governing authority of the largest municipality of the county, by whatever name called, or some member designated by said officer; provided, however, that whenever the legal situs of such largest municipality lies within an adjoining county, the county governing authority may adopt an ordinance providing:
      1. For the selection by the county governing authority of the chief executive officer, by whatever name designated, of the governing authority of any municipality lying wholly or partially within the county to fill the position on the county board of health authorized by this paragraph;
      2. That the chief executive officer so selected may designate another member of the respective municipal governing authority, whose term of office is the same as that of the chief executive officer, to serve in the place of the chief executive officer;
      3. That the chief executive officer so selected or the chief executive officer's designee shall serve for a term of office as a member of the county board of health concurrent with the term of office as a member of the municipal governing authority;
      4. That a vacancy in the position on the county board of health which is held by the chief executive officer or the chief executive officer's designee shall be filled for the unexpired term by the county governing authority; and
      5. That the first member of the county board of health selected by the county governing authority under such ordinance may take office at any time on or after January 1, 1987, and that the term of office of the member of the county board of health holding office pursuant to this paragraph on December 31, 1986, shall expire on the day immediately preceding the day such first member selected under such ordinance takes office.
2. No member appointed to the county board of health shall be an employee of the county board of health or of the department.
3. The terms of the members of county boards of health serving as such on June 30, 1985, and who are serving in membership positions required to be filled by grand jury appointment, shall expire at the end of June 30, 1985, and upon the appointment and qualification of their successors.
4. The initial term of the member first appointed pursuant to paragraph (3) of subsection (a) of this Code section shall begin July 1, 1985, and shall expire December 31, 1987; the initial term of the member first appointed pursuant to paragraph (4) of subsection (a) of this Code section shall begin July 1, 1985, and shall expire December 31, 1986; the initial term of the member first appointed pursuant to paragraph (6) of subsection (a) of this Code section shall begin July 1, 1984, and expire December 31, 1985; and the initial term of the member first appointed pursuant to paragraph (5) of subsection (a) of this Code section shall begin July 1, 1984, and shall expire December 31, 1986. After these initial terms, members appointed pursuant to paragraphs (3), (4), (5), and (6) of subsection (a) of this Code section shall take office the first day of January immediately following the expiration of the immediately preceding term of that office and serve terms of six years and until their successors are appointed and qualified. Vacancies in any such membership shall be filled, for the unexpired term and until a successor is appointed and qualified, in the same manner as the original appointment.
5. Persons holding office as members pursuant to paragraph (1), (2), or (7) of subsection (a) of this Code section shall serve as members while holding their offices as chief executive officer of the governing authority of the county, county superintendent of schools, or chief executive officer of the largest municipality of the county, respectively.
6. In each county having a population of not less than 400,000 and not more than 500,000 according to the United States decennial census of 1990 or any future such census, the superintendent of the largest municipal school system in the county shall serve in an ex officio capacity as an additional member of the county board of health.

   (Ga. L. 1914, p. 124, § 2; Code 1933, § 88-201; Code 1933, § 88-202, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1967, p. 544, § 1; Ga. L. 1982, p. 506, § 1; Ga. L. 1984, p. 1325, § 1; Ga. L. 1985, p. 149, § 31; Ga. L. 1986, p. 1242, § 1; Ga. L. 1987, p. 185, § 1; Ga. L. 1992, p. 1217, § 1; Ga. L. 1993, p. 1445, § 1; Ga. L. 1998, p. 855, § 1.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1986, "who" was deleted preceding "shall" in paragraphs (a)(4) through (a)(6).

Editor's notes. - Ga. L. 1993, p. 1445, § 18.1, not codified by the General Assembly, provides: "Nothing in this Act shall be construed to repeal any provision of Chapter 5 of Title 37 of the Official Code of Georgia Annotated, the 'Community Services Act for the Mentally Retarded.' "

31-3-2.1. Option for certain counties to create board of health and wellness by ordinance.

Repealed by Ga. L. 2016, p. 520, § 1/HB 885, effective April 27, 2016.

Editor's notes. - This Code section was based on Code 1981, § 31-3-2.1 , enacted by Ga. L. 1985, p. 384, § 1; Ga. L. 1987, p. 169, § 1; Ga. L. 1991, p. 94, § 31; Ga. L. 1998, p. 916, § 1; Ga. L. 2002, p. 1473, § 1.

Ga. L. 2016, p. 520, § 2/HB 885, not codified by the General Assembly, provides: "This Act shall become effective upon its approval by the Governor or upon its becoming law without such approval; provided, however, that for any county board of health and wellness which was established by county ordinance pursuant to the former provisions of Code Section 31-3-2.1 and which is still in existence as of the effective date of this Act, the members of such board shall remain in office and such board shall remain in existence until a county board of health is constituted pursuant to Code Section 31-3-2 for such county or until June 30, 2017, whichever occurs first."

31-3-3. Duty to inform department of membership.

The county board of health shall keep the department informed of the names, addresses, and terms of office of its members.

(Code 1933, § 88-208, enacted by Ga. L. 1964, p. 499, § 1.)

31-3-4. Powers.

1. The county board of health is empowered to:
   1. Establish and adopt bylaws for its own governance. Meetings shall be held no less frequently than quarterly;
   2. Exercise responsibility and authority in all matters within the county pertaining to health unless the responsibility for enforcement of such is by law that of another agency;
   3. Take such steps as may be necessary to prevent and suppress disease and conditions deleterious to health and to determine compliance with health laws and rules, regulations, and standards adopted thereunder;
   4. Adopt and enforce rules and regulations appropriate to its functions and powers, provided such rules and regulations are not in conflict with the rules and regulations of the department. Such rules and regulations must be reasonably adapted to the purposes intended and must be within the purview of the powers and duties imposed upon the county board of health by this chapter;
   5. Receive and administer all grants, gifts, moneys, and donations for purposes pertaining to health pursuant to this chapter;
   6. Make contracts and establish fees for the provision of public health services provided by county boards of health, including but not limited to environmental health services, which fees may be charged to persons or to establishments and premises within the county for inspection of such establishments, premises, structures and appurtenances thereto, or for other county board of health services.  All such fees may be used to defray costs of providing such local services and shall supplement but not replace state or federal funding.  No person shall be denied services on the basis of that person's inability to pay.  The scope of services, operating details, contracts, and fees approved by the county board of health shall also be approved by the district director of health.  No fees for environmental health services may be charged unless the schedule of fees for such services has been approved by the county governing authority;
   7. Contract with the Department of Public Health or other agencies for assistance in the performance of its functions and the exercise of its powers and for supplying services which are within its purview to perform, provided that such contracts and amendments thereto shall have first been approved by the department. In entering into any contracts to perform its functions and to exercise its powers, and for supplying services which are within its purview to perform, any county board of health or any health district created under the authority of Code Section 31-3-15 shall be considered an agency and such agency shall have the authority to contract with any other county board of health; combination of county boards of health; any other health district; public or private hospitals; hospital authorities; medical schools; training and educational institutions; departments and agencies of the state; county or municipal governments; persons, partnerships, corporations, and associations, public or private; the United States government or the government of any other state; or any other legal entity; and
   8. The county board of health in each county of this state having a population of 400,000 or more according to the United States decennial census of 1990 or any future such census is authorized to develop and implement activities for the prevention of injuries and incorporate injury prevention measures in rules and regulations which are within the purview of the county board of health to promulgate which shall be effective when adopted by an ordinance of the county governing authority.
2. Notwithstanding the provisions contained in subsection (a) of this Code section and Code Section 31-3-5, nothing contained in this Code section or Code Section 31-3-5 shall be construed to empower a county board of health to adopt any rules or regulations or provisions to enforce any rules or regulations pertaining to matters provided for or otherwise regulated pursuant to the provisions of Part 1 of Article 2 of Chapter 8 of Title 12, the "Georgia Comprehensive Solid Waste Management Act," as now or hereafter amended, or the rules and regulations promulgated pursuant to such part.

   (Code 1933, § 88-204, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1966, p. 380, § 1; Ga. L. 1976, p. 1420, § 1; Ga. L. 1978, p. 2031, § 1; Ga. L. 1984, p. 1325, § 2; Ga. L. 1985, p. 419, § 1; Ga. L. 1988, p. 1757, § 1; Ga. L. 1992, p. 1204, § 1; Ga. L. 1992, p. 3308, § 1.1; Ga. L. 1993, p. 1445, § 2; Ga. L. 2009, p. 453, § 1-4/HB 228; Ga. L. 2011, p. 705, § 6-3/HB 214.)

Cross references. - Regulation of restaurants, taverns, and other establishments by county boards of health and Department of Public Health, § 26-2-370 et seq.

Inspection of funeral establishments by county boards of health, § 43-18-75 .

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1992, "such part" was substituted for "such Act" at the end of subsection (b).

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-3-5. Functions.

1. Subject to the provisions of Code Section 31-2A-11 and subsection (b) of this Code section, each county board of health shall have and discharge, within its jurisdiction, subject to any valid local Act which shall remain in force and effect, the following functions:
   1. To determine the health needs and resources of its jurisdiction by research and by collection, analysis, and evaluation of all data pertaining to the health of the community;
   2. To develop, in cooperation with the department, programs, activities, and facilities responsive to the needs of its area;
   3. To secure compliance with the rules and regulations of the department that have local application; and
   4. To enforce, or cause enforcement of, all laws pertaining to health unless the responsibility for the enforcement of such laws is that of another agency.
2. Each county board of health shall have the power and duty to adopt regulations providing standards and requirements governing the installation of on-site sewage management systems within the incorporated and unincorporated area of the county, subject to the provisions of Code Section 31-2A-11, any rules and regulations promulgated under Code Section 31-2A-11, and subsection (d) of this Code section. Such regulations shall include and be limited to the following:
   1. Specifying the locations within the incorporated and unincorporated area of the county where on-site sewage management systems may be installed;
   2. Specifying the minimum lot size or land area which may be served by an on-site sewage management system based on scientific data regarding on-site sewage management systems;
   3. Specifying the types of residences, buildings, or facilities which may be served by on-site sewage management systems;
   4. Issuing permits for the installation of on-site sewage management systems prior to such installation;
   5. Inspecting on-site sewage management system installations prior to the completion of the installation; and
   6. Providing for ongoing maintenance of such systems, except for nonmechanical residential sewage management systems.
3. Nothing in this Code section or in Code Section 31-3-5.1 shall limit the power of a county or municipal governing authority to exercise its zoning powers or to establish minimum lot sizes larger than the minimum lot sizes specified pursuant to subsection (b) of this Code section.
4. 1. Any person may register with the department to conduct soil investigations and prepare soil reports of a site within the state for an on-site sewage management system who meets any one of the following criteria:
      1. Qualifies as a soil classifier as defined in subparagraph (B) of paragraph (3) of this subsection;
      2. Holds a valid certificate of registration as a professional engineer issued pursuant to Chapter 15 of Title 43 and is practicing within his or her area of engineering competency;
      3. Holds a valid certificate of registration as a registered geologist issued pursuant to Chapter 19 of Title 43 and is practicing within his or her area of geologic competency; or
      4. Is a soil and water conservation technician as defined in subparagraph (A) of paragraph (3) of this subsection.
   2. Upon the submission of an evaluation of the suitability of a site within the state for an on-site sewage management system by such a person who is registered with the department, the county board of health shall be required to accept the evaluation unless such evaluation is found by the county board of health to be deficient or questionable. If the county board of health finds such evaluation to be deficient or questionable, the board shall, within three working days of making such finding, issue a written determination stating all deficiencies and all measures needed to correct the deficiencies. A copy of this determination shall be provided to the state director of environmental health.
   3. As used in this subsection, the term:
      1. "Soil and water conservation technician" means a person employed as a soil and water conservation technician by a soil and water conservation district provided for in Article 2 of Chapter 6 of Title 2.
      2. "Soil classifier" means a person who:
         1. Holds at least a bachelor of science degree from an accredited college or university with a major in soil science or a related field of science. This degree shall include 30 semester credit hours or equivalent quarter credit hours in the biological, physical, chemical, and earth sciences with a minimum of 15 semester credit hours or equivalent quarter hours in soil science courses meeting the following distribution:
            1. A minimum of one course in soil classification, morphology, genesis, and mapping; and
            2. The remaining soil science credits must be in at least three of the following eight categories: introductory soil science; soil fertility; soil microbiology; soil chemistry; soil physics; soil management, soils and land use, or soils and the environment; soil mineralogy; or a three credit maximum in independent study, geology, or hydrology; and
         2. Has at least four years of verifiable full-time or equivalent part-time experience under the supervision of a soil classifier who has met the education and experience requirements provided in this subparagraph. Such experience must be obtained after meeting all educational requirements defined in this subparagraph and must have been spent actively mapping, identifying, and classifying soil features and interpreting the influence of soil features on soil uses including, but not limited to, conducting soil investigations for determining the suitability of sites for on-site sewage management systems as approved by the department's soil classifiers advisory committee; and
         3. Has successfully passed a written examination pertaining to site investigations for on-site sewage management systems administered or approved by the department.

            (Code 1933, § 88-203, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1985, p. 149, § 31; Ga. L. 1997, p. 708, § 2; Ga. L. 2000, p. 549, § 1; Ga. L. 2003, p. 302, § 1; Ga. L. 2009, p. 453, § 1-10/HB 228; Ga. L. 2011, p. 705, § 3-3/HB 214.)

Cross references. - Powers and duties of county boards of health with regard to providing of mental health and developmental disabilities services, T. 37, C. 2.

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2000, subparagraphs (d)(1)(A) and (d)(1)(B) (now subparagraphs (d)(3)(A) and (d)(3)(B)) were placed in alphabetical order.

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-3-5.1. Conformity prerequisite to building permit.

No building permit for the construction of any residence, building, or other facility which is to be served by a sewage management system shall be issued by or pursuant to the authority of a county governing authority unless the sewage management system installation permit is in conformity with standards contained in Code Section 31-2A-11 for sewage management systems. No person, firm, corporation, or other entity shall install a sewage management system in violation of the provisions of Code Section 31-2A-11 or the regulations of a county board of health adopted pursuant to the authority of Code Section 31-3-5. Each county governing authority shall provide by ordinance or resolution for the enforcement of the provisions of this Code section.

(Code 1981, § 31-3-5.1 , enacted by Ga. L. 1986, p. 227, § 1; Ga. L. 1992, p. 3308, § 2; Ga. L. 1994, p. 1777, § 2; Ga. L. 1997, p. 708, § 3; Ga. L. 2009, p. 453, § 1-10/HB 228; Ga. L. 2011, p. 705, § 3-3/HB 214.)

Cross references. - Building standards and requirements generally, T. 8, C. 2.

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-3-5.2. Definition of "gray water"; lawful use.

1. As used in this Code section, the term "gray water" means waste water discharged from residential lavatories, bathtubs, showers, clothes washers, and laundry trays.
2. Private residential direct reuse of gray water shall be lawful if the following conditions are met:
   1. Gray water originating from the residence shall be used and contained within the property boundary for household gardening, composting, lawn watering, or landscape irrigation;
   2. Gray water shall not be used for irrigation of food plants;
   3. The gray water shall not contain hazardous chemicals derived from activities such as cleaning car parts, washing greasy or oily rags, or disposing of waste solutions from home photography laboratories or similar hobbyist or home occupational activities;
   4. The application of gray water shall be managed to minimize standing water on the surface;
   5. The application of gray water shall be outside of a floodway;
   6. The gray water shall not contain water used to wash diapers or similarly soiled or infectious garments unless the gray water is disinfected before irrigation; and
   7. The gray water shall be applied only by hand watering using garden watering cans or similar hand-held containers.
3. County boards of health shall adopt the provisions of subsection (b) of this Code section by regulation. Local governing bodies shall be authorized to punish violations of said regulations as local ordinance violations, provided that the penalty for each such violation shall not exceed a $100.00 fine. (Code 1981, § 31-3-5.2 , enacted by Ga. L. 2008, p. 720, § 1/SB 463; Ga. L. 2009, p. 8, § 31/SB 46.)

31-3-6. Rules and regulations of local application.

The county board of health shall have authority to establish rules and regulations which apply to all citizens and premises of the county or to specified areas and citizens therein without regard to the remainder of the county.

(Code 1933, § 88-205, enacted by Ga. L. 1964, p. 499, § 1.)

31-3-7. Compensation for members' attendance at meetings.

Members of county boards of health shall be paid not more than $25.00 per day for their attendance at meetings of the board, provided funds therefor have been established by budget and are available from funds allocated to that purpose.

(Code 1933, § 88-206, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1989, p. 312, § 1.)

31-3-8. Records.

The county board of health shall record and preserve true and correct minutes of its proceedings in a book kept for that purpose and shall maintain or cause to be maintained, unless maintained by the governing authority of the county, accurate double entry accounting records including but not limited to:

1. Prenumbered duplicates of receipts issued for funds received showing the source of such funds; and
2. Records and financial reports including a general ledger maintained in accordance with generally accepted principles of accounting and in accordance with such standards as may be prescribed by the governing authority of the county and the department. Such records shall show all receipts and disbursements, identifying each item and, in the case of disbursements, listing to whom paid, dates, amounts, and objects of expenditure. All accounting records shall be subject to any audits made of general county financial operations and shall be made available for the purpose of such audits.

   (Code 1933, § 88-207, enacted by Ga. L. 1964, p. 499, § 1.)

Cross references. - Requirements of audit reports generally, § 36-60-8 .

31-3-9. Office quarters and equipment.

The governing body of the county shall provide the county board of health with quarters and equipment sufficient for its operation.

(Code 1933, § 88-209, enacted by Ga. L. 1964, p. 499, § 1.)

31-3-10. Legal representation.

The county board of health may require the legal services of the county attorney or, its budget permitting, may employ other counsel to assist in performing its duties.

(Code 1933, § 88-210, enacted by Ga. L. 1964, p. 499, § 1.)

31-3-11. Appointments of director and staff; supervision.

1. The county board of health shall appoint as its chief executive officer a director who shall be a physician licensed to practice medicine under Chapter 34 of Title 43 and who otherwise meets the requirements of the rules of the State Personnel Board. The director, subject to the approval of the county board of health, shall designate aides and assistants pursuant to the budget adopted by the county board of health in accordance with Code Section 31-3-14.
2. Each employee of a county board of health whose duties include enforcing those environmental health laws of this state or environmental health regulations of that board of health relating to septic tanks or individual sewage management systems shall be subject to the direction and supervision of the district director of environmental health, although the hiring and termination from employment of such employee shall be subject to the director of that county board of health. The employment activities of such employee with regard to environmental health shall be reported to the director of environmental health through the district director of environmental health at least quarterly. The director of environmental health may recommend to that director of that county board of health personnel actions, including but not limited to termination, which the director of environmental health deems appropriate for such employee's failure or refusal to comply with the direction of the director of environmental health in the carrying out of the environmental health employment duties of such employee. As used in this subsection, the term "director of environmental health" means the director of environmental health of the Department of Public Health.

   (Code 1933, § 88-211, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 2000, p. 549, § 2; Ga. L. 2009, p. 453, § 1-4/HB 228; Ga. L. 2009, p. 745, § 2/SB 97; Ga. L. 2011, p. 705, § 6-1/HB 214; Ga. L. 2012, p. 446, § 2-35/HB 642.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2000, "environmental" was substituted for "environment" near the end of the second sentence of subsection (b).

Editor's notes. - Ga. L. 2012, p. 446, § 3-1/HB 642, not codified by the General Assembly, provides that: "Personnel, equipment, and facilities that were assigned to the State Personnel Administration as of June 30, 2012, shall be transferred to the Department of Administrative Services on the effective date of this Act." This Act became effective July 1, 2012.

Ga. L. 2012, p. 446, § 3-2/HB 642, not codified by the General Assembly, provides that: "Appropriations for functions which are transferred by this Act may be transferred as provided in Code Section 45-12-90."

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-3-12. Duties of director.

Subject to the policies and directives of the county board of health and the policies and directives of the multiple county districts served, the director shall perform the functions and exercise the powers set forth in this chapter except the power to adopt bylaws and to adopt rules and regulations and may delegate the powers and authority conferred, or any part thereof, to one or more individuals as he may deem appropriate. The director shall devote his entire time to the service of the county board of health and to the multiple county districts, where created, and shall be vigilant in procuring compliance with its rules and regulations and with Georgia health laws and rules and regulations adopted thereunder that have application within the county and district. He shall make reports to the county board of health and the agency in charge of the multiple county district in such manner and form and with such frequency as required by it and shall also report to the department in such manner, detail, and form as the department may specify.

(Code 1933, § 88-212, enacted by Ga. L. 1964, p. 499, § 1.)

31-3-12.1. Contracts between county boards; authorization for and provisions applicable to county board of health serving as community service board.

1. In addition to any other power authorized by law, the county governing authority may authorize the county board of health to enter into a contract with the Department of Behavioral Health and Developmental Disabilities or a community mental health, developmental disabilities, and addictive diseases service board created under Chapter 2 of Title 37 to provide certain mental health, developmental disabilities, and addictive diseases services based on the contractual agreement between the parties. In the event that the county governing authority exercises the authority granted by this subsection, the county board of health shall appoint a director for mental health, developmental disabilities, and addictive diseases or a supervisor of the specific service which is being provided by the county board of health, whichever is applicable, who shall meet the requirements established by this subsection. The director for mental health, developmental disabilities, and addictive diseases, or the service supervisor, shall not be required to be a physician and shall be a person other than the director of the county board of health appointed pursuant to Code Section 31-3-11. Further, such director for mental health, developmental disabilities, and addictive diseases or such supervisor of the specific service shall report directly to the county board of health and shall have no formal reporting relationship with the director of the county board of health.
2. Pursuant to subsection (e) of Code Section 37-2-6 , a county governing authority may authorize the membership of a county board of health to serve as the membership of a community mental health, developmental disabilities, and addictive diseases service board, provided that the county governing authority, the county board of health, and any other affected county governing authority act pursuant to subsection (e) of Code Section 37-2-6 . If the membership of a county board of health exercises the authority granted pursuant to this subsection and Chapter 2 of Title 37 to serve as the membership of a community service board, the membership of the county board of health shall constitute the membership of the community service board and, at any time that such members are exercising duties and powers related to mental health, developmental disabilities, and addictive diseases, the community service board shall be an independent agency and shall operate in accordance with the provisions of Title 37 as a community service board. Notwithstanding any provisions of law to the contrary, a community service board and a county board of health which have the same membership may contract with each other, provided that any such contract is approved by the department and the Department of Behavioral Health and Developmental Disabilities prior to adoption. (Code 1981, § 31-3-12.1 , enacted by Ga. L. 1993, p. 1445, § 3; Ga. L. 1994, p. 437, § 1; Ga. L. 2002, p. 1324, § 1-3; Ga. L. 2006, p. 310, § 1/HB 1223; Ga. L. 2009, p. 453, § 3-9/HB 228.)

Editor's notes. - Ga. L. 1993, p. 1445, § 18.1, not codified by the General Assembly, provides: "Nothing in this Act shall be construed to repeal any provision of Chapter 5 of Title 37 of the Official Code of Georgia Annotated, the 'Community Services Act for the Mentally Retarded.' "

Ga. L. 2006, p. 310, § 10/HB 1223, not codified by the General Assembly, provides that: "Nothing in this Act shall be construed to affect or abate any right accrued or vested prior to July 1, 2006, or any action or proceeding commenced prior to July 1, 2006, under any law amended or repealed by this Act."

Ga. L. 2006, p. 310, § 11/HB 1223, not codified by the General Assembly, provides that: "This Act shall become effective July 1, 2006, except that those provisions which authorize community service boards to amend their bylaws and authorize county governing authorities to appoint no sooner than May 1, 2006, any community service board members to take office on July 1, 2006, shall become effective upon the approval of this Act by the Governor or upon its becoming law without such approval." This Act was approved by the Governor on April 21, 2006.

31-3-13. Declaration of public policy; contracts for assistance to boards.

No population area or unit of this state shall be without health services responsive to its needs. Because it is recognized that all counties are not equally able to effectuate this policy, a county board of health may contract for assistance in the performance of its functions and exercise of its powers, provided that such proposed contract and any amendments thereto shall have first been approved by the department.

(Code 1933, § 88-213, enacted by Ga. L. 1964, p. 499, § 1.)

31-3-14. Financing of expenses.

The county board of health, at a regular or called meeting, at a time appropriate to the fiscal operation of the county, shall determine and fix the amount of money needed for the fiscal or calendar year, as the case may be, in accordance with a budget itemizing anticipated income and expenditure; the budget shall include any unobligated moneys carried over from the current period and funds to be made available from sources other than county taxes. The expenditures anticipated, after applying credits, shall be certified by the county board of health, with a copy of the budget, to the taxing authority of the county, which may fix and levy a tax rate sufficient to raise such amount at the same time and in the same manner prescribed for levying taxes for other county purposes, provided the taxing authority of the county deems the budget reasonable. If, however, the taxing authority of the county should deem the budget unreasonable, it shall promptly return the budget to the county board of health with its objections attached thereto for the purpose of resubmission.

(Code 1933, § 88-214, enacted by Ga. L. 1964, p. 499, § 1.)

31-3-15. Establishment of health districts.

The department is authorized, with the consent of the boards of health and the county authorities of the counties involved, to establish health districts composed of one or more counties. The county boards of health of the constituent counties shall, at the call of the commissioner, meet in joint session to approve the selection of a director appointed by the commissioner to serve such boards in common. A county board of health is authorized to appoint one of its members to represent the board at a joint meeting for this purpose. The director shall be a physician who is licensed to practice medicine under Chapter 34 of Title 43 and who otherwise meets the requirements of the rules of the State Personnel Board. The district director shall have the same powers, duties, and responsibility as a director serving a single county board of health. To further the purposes of this Code section, county boards of health may contract with each other for the provision of multicounty services and also exercise any additional powers as authorized by paragraph (7) of subsection (a) of Code Section 31-3-4; and in the performance of such contracts a county board of health may utilize its employees in other counties.

(Code 1933, § 88-215, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1978, p. 2031, § 2; Ga. L. 2009, p. 745, § 2/SB 97; Ga. L. 2012, p. 446, § 2-36/HB 642.)

Editor's notes. - Ga. L. 2012, p. 446, § 3-1/HB 642, not codified by the General Assembly, provides that: "Personnel, equipment, and facilities that were assigned to the State Personnel Administration as of June 30, 2012, shall be transferred to the Department of Administrative Services on the effective date of this Act." This Act became effective July 1, 2012.

Ga. L. 2012, p. 446, § 3-2/HB 642, not codified by the General Assembly, provides that: "Appropriations for functions which are transferred by this Act may be transferred as provided in Code Section 45-12-90."

31-3-16. Enforcement under local ordinances.

It is not the intent of this chapter to abrogate the terms of a municipal charter or laws of local application which authorize a governing body within the county to provide penalties for a violation of a valid rule and regulation of the county board of health.

(Code 1933, § 88-218, enacted by Ga. L. 1964, p. 499, § 1.)

31-4-1 through 31-4-3.

Reserved. Repealed by Ga. L. 2009, p. 453, § 2-15/HB 228, effective July 1, 2009.

Editor's notes. - This chapter consisted of Code Sections 31-4-1 through 31-4-3 and was based on Ga. L. 1972, p. 635, §§ 1, 2, 3; Ga. L. 1974, p. 269, § 1; Ga. L. 1978, p. 1763, § 1; Ga. L. 1979, p. 766, § 1; Ga. L. 1982, p. 3, § 31.

31-5-1. Adoption of rules and regulations.

All rules and regulations of the Department of Public Health and any county board of health shall be adopted after due notice to and hearing by persons and parties affected thereby; and such rules and regulations shall be maintained in a book kept for that purpose, orderly arranged and indexed and subject to inspection by the public during regular business hours. The agency adopting such rules and regulations shall make copies thereof available for distribution to persons interested in or affected thereby. Such agencies are also authorized to provide for the mimeographing, printing, or other reproduction of their regulations and the distribution thereof. No rule or regulation shall become effective as law until 30 days after its adoption, except in cases of emergencies constituting an imminent threat to the public, in which event such rules or regulations shall become effective upon adoption; but, in all such cases, the agency adopting same shall as a part thereof state the conditions found by it to justify such immediate effectiveness. Where deemed desirable by the agency, hearing and notice as provided in Code Section 31-5-2 may be conducted by it prior to adoption of any rule or regulation.

(Code 1933, § 88-307, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 2009, p. 453, § 1-4/HB 228; Ga. L. 2011, p. 705, § 6-3/HB 214.)

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-5-2. Hearings.

Hearings shall be required for any and all quasi-judicial actions and in any other proceeding required by this title or the Constitution of Georgia. All such hearings shall be conducted in accordance with Chapter 13 of Title 50, the "Georgia Administrative Procedure Act."

(Code 1933, § 88-304, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1977, p. 309, § 1; Ga. L. 1993, p. 1290, § 2; Ga. L. 1995, p. 10, § 31; Ga. L. 2000, p. 1589, § 3; Ga. L. 2009, p. 453, § 1-22/HB 228.)

Editor's notes. - Ga. L. 2000, p. 1589, § 16, not codified by the General Assembly, provided that the 2000 amendment was applicable to notices delivered on or after July 1, 2000.

31-5-3. Appeals.

1. 1. Any person who is a party to a proceeding and who is aggrieved or adversely affected by any final order or action of a county board of health or agency of the department may have review thereof by appeal to the department. Any person who is a party to a proceeding and who is aggrieved or adversely affected by any final order or action of the department may have review thereof by appeal to the superior court in the county in which the action arose or to the Superior Court of Fulton County.
   2. Appeals to the department shall be heard by it after not less than 20 days' notice delivered by certified mail or statutory overnight delivery is given to all parties and their counsel of record, at such times and places as are set forth in such notice; provided, however, if such appeal is not heard and determined within a period of 90 days, the decision shall stand reversed unless all parties consent to an extension of time. Review on appeal to the department shall be confined to the record transmitted from below and the questions raised in the appeal. Orders, rules, regulations, or other decisions of county boards of health or other agencies of the department shall not be set aside on appeal to the department unless contrary to law or rules and regulations of the department, or unsupported by substantial evidence on the record as a whole, or unreasonable.
   3. Appeal to the superior court shall be by petition which shall be filed in the clerk's office of such court within 30 days after the final order or action of the department; the petition shall set forth the names of the parties taking the appeal, the order, rule, regulation, or decision appealed from, and the reason it is claimed to be erroneous. The enforcement of the order or action appealed from shall not be stayed until and unless so ordered and directed by the reviewing court. A reviewing court may order a stay only if the court makes a finding that the public health, safety, and welfare will not be harmed by the issuance of the stay. Upon the filing of such petition, the petitioner shall serve on the commissioner a copy thereof in a manner prescribed by law for the service of process, unless such service of process is waived. The review shall be conducted by the court without a jury and shall be confined to the record. In cases of alleged irregularities in procedure before the department, not shown in the record, proof thereon may be taken in the court. The court, upon request, shall hear oral argument and receive written briefs. The court shall not substitute its judgment for that of the department as to the weight of the evidence on questions of fact. The court may affirm the decision of the department or remand the case for further proceedings. The court may reverse or modify the decision if substantial rights of the appellant have been prejudiced because the administrative findings, inferences, conclusions, or decisions are:
      1. In violation of constitutional or statutory provisions;
      2. In excess of the statutory authority of the department;
      3. Made upon unlawful procedure;
      4. Affected by other error of law;
      5. Clearly erroneous in view of the reliable, probative, and substantial evidence on the whole record; or
      6. Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.
2. Upon perfection of the appeal as provided in subsection (a) of this Code section, it shall be the duty of the agency whose order, rule, regulation, or decision is under review by the department to cause a transcript of all pleadings, orders, evidence, and other proceedings including a copy of the appeal and motion for reconsideration, if any, filed with it to be transmitted to the department or the superior court in not more than 30 days. For the proceedings not reported, the agency or the department shall cause to be written out a narrative transcript of all evidence and proceedings before it under certificate of its director or examiner or other official conducting such hearings.

   (Code 1933, § 88-305, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1986, p. 1280, § 1; Ga. L. 2000, p. 1589, § 3.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1986, in paragraph (a)(3) the paragraphs (1) through (6) added were redesignated as subparagraphs (a)(3)(A) through (a)(3)(F), respectively.

Editor's notes. - Ga. L. 2000, p. 1589, § 16, not codified by the General Assembly, provided that the 2000 amendment was applicable to notices delivered on or after July 1, 2000.

Law reviews. - For annual survey of administrative law, see 38 Mercer L. Rev. 17 (1986).

31-5-4. Testimony or production of evidence by compulsory process.

The testimony of any witnesses or the production of any books, papers, records, documents, physical objects, or other evidence for inspection may be compelled by any superior court of competent jurisdiction on application of the department or any county board of health seeking such process.

(Code 1933, § 88-303, enacted by Ga. L. 1964, p. 499, § 1.)

31-5-5. Classification of confidential and privileged materials.

The department and county boards of health are authorized by regulation to classify as confidential and privileged documents, reports and other information and data obtained by them from persons, firms, corporations, municipalities, counties, and other public authorities and political subdivisions, where such matters relate to secret processes, formulas, and methods or where such matters were obtained or furnished on a confidential basis. All matters so classified shall not be subject to public inspection or discovery and shall not be subject to production or disclosure in any court of law or elsewhere until and unless the judge of the court of competent jurisdiction, after in camera inspection, determines that the public interest requires such production and disclosure or that such production and disclosure may be necessary in the interests of justice.

(Code 1933, § 88-306, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 2011, p. 99, § 42/HB 24.)

Editor's notes. - Ga. L. 2011, p. 99, § 101/HB 24, not codified by the General Assembly, provides that this Act shall apply to any motion made or hearing or trial commenced on or after January 1, 2013.

Law reviews. - For article, "Evidence," see 27 Ga. St. U. L. Rev. 1 (2011). For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 1 (2011).

31-5-6. Distribution of rules.

The department and all county boards of health are directed to prescribe and make available for distribution the rules of practice and procedure to implement this chapter.

(Code 1933, § 88-308, enacted by Ga. L. 1964, p. 499, § 1.)

31-5-7. Application of this chapter.

This chapter shall apply to all other chapters of this title and all amendments hereafter enacted with respect thereto unless provided otherwise expressly or by necessary implication.

(Code 1933, § 88-309, enacted by Ga. L. 1964, p. 499, § 1.)

31-5-8. Penalty for violations of the provisions of this title.

Any person violating the provisions of this title shall be guilty of a misdemeanor, provided that this Code section shall not apply to violations of the provisions of Chapter 20, 22, or 24 of this title.

(Code 1933, § 88-301, enacted by Ga. L. 1964, p. 499, § 1.)

31-5-9. Injunctions for enjoining violations of the provisions of this title; supersedeas; attachment for contempt; injunctions to abate public nuisances; where actions may be instituted.

1. The Department of Public Health and all county boards of health and the Department of Community Health, as appropriate, are empowered to institute appropriate proceedings for injunction in the courts of competent jurisdiction in this state for the purpose of enjoining a violation of any provision of this title as now existing or as may be hereafter amended or of any regulation or order duly issued by the department, any county board of health, or the Department of Community Health provided that this Code section shall not apply to violations of the provisions of Chapter 20 of this title. The department, the county boards of health, and the Department of Community Health, as appropriate, are also empowered to maintain action for injunction to abate any public nuisance which is injurious to the public health, safety, or comfort. Such actions may be maintained notwithstanding the fact that such violation also constitutes a crime and notwithstanding that other adequate remedies at law exist. Such actions may be instituted in the name of the department, any county board, or the Department of Community Health, as the case may be, in the county in which a violation of any provision of this title occurs. For purposes of this Code section, the county boards of health are declared to be legal entities capable of maintaining actions in their respective names without naming the individuals constituting such board, or acting on behalf of the department, as the case may be.
2. Notwithstanding the provisions of Code Section 5-6-13, an appeal or a notice of intent to appeal an adjudication of contempt of court of a party subject to an interlocutory or final judgment in a court action for an injunction instituted under authority of this Code section for a violation of a licensing requirement of this title shall not operate as a supersedeas unless it is so ordered by the court; provided, however, that the court may grant a supersedeas in such a case after making a finding that the health, safety, or welfare of the recipients of the services will not be substantially harmed by the issuance of the stay.
3. Unless otherwise ordered by the court pursuant to subsection (b) of this Code section, an interlocutory or final judgment in an action granting an injunction under this Code section may be enforced by attachment for contempt.

   (Code 1933, § 88-302, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1997, p. 544, § 1; Ga. L. 1998, p. 128, § 31; Ga. L. 2009, p. 453, § 1-4/HB 228; Ga. L. 2011, p. 705, § 5-10/HB 214.)

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011).

31-5-10. Notifying department or board of health of conditions on private property which are injurious to the public; inspection warrant; notice to owner and occupant; abatement.

1. The provisions of this Code section shall apply only in those counties of this state having a population of 450,000 or more according to the United States decennial census of 1980 or any future such census.
2. Any person who knows or suspects that a condition exists on private property, which condition is injurious to the public health, safety, or comfort, shall immediately notify the Department of Public Health or the county board of health. Upon receiving such notice, the department or the county board of health shall be authorized to obtain an inspection warrant as provided in Code Section 31-5-21. If the department or the county board of health determines that there exists a condition which is injurious to the public health, safety, or comfort, the department or county board of health shall, by registered or certified mail or statutory overnight delivery with return receipt requested, notify the occupants of the property and, if different from the occupant, the person, firm, or corporation which owns the property. Notice to the owner shall be sent to the address shown on the county or municipal property tax records.
3. If the department or the county board of health brings an action for injunction to abate a public nuisance which is injurious to the public health, safety, or comfort, process shall be served on the occupants of the property and on any person, firm, or corporation having any interest in the property according to the county property records. Service shall be made in accordance with Code Section 9-11-4; and, if any person, firm, or corporation to be served resides outside the state, has departed the state, cannot, after due diligence, be found within the state, or conceals himself to avoid the service of summons, the judge or clerk may make an order that the service be made by publication of summons as provided in Code Section 9-11-4.
4. In addition to any form of relief ordered by the court, the superior court may, as a part of its order, authorize the department or the county board of health to take appropriate action to abate such public nuisance. Any cost incurred by the department or the county board of health to abate such nuisance shall constitute a lien against the property, and such lien shall have the same status and priority as a lien for taxes. (Code 1981, § 31-5-10 , enacted by Ga. L. 1985, p. 388, § 1; Ga. L. 2000, p. 1589, § 3; Ga. L. 2015, p. 598, § 1-10/HB 72.)

Editor's notes. - Ga. L. 2000, p. 1589, § 16, not codified by the General Assembly, provided that the 2000 amendment was applicable to notices delivered on or after July 1, 2000.

Law reviews. - For article on the 2015 amendment of this Code section, see 32 Ga. St. U. L. Rev. 63 (2015).

31-5-20. "Inspection warrant" defined.

As used in this article, the term "inspection warrant" means a warrant authorizing a search or inspection of private property where such a search or inspection is one that is necessary for the enforcement of any of the provisions of laws authorizing licensure, inspection, or regulation by the Department of Public Health or a local agency thereof.

(Code 1933, § 88-301A, enacted by Ga. L. 1975, p. 693, § 1; Ga. L. 1982, p. 1667, §§ 1, 2; Ga. L. 2009, p. 453, § 1-4/HB 228; Ga. L. 2011, p. 705, § 5-11/HB 214; Ga. L. 2015, p. 598, § 1-11/HB 72.)

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011). For article on the 2015 amendment of this Code section, see 32 Ga. St. U. L. Rev. 63 (2015).

31-5-21. Persons who may obtain inspection warrants; authorization of searches and inspections of property.

The commissioner of public health or his or her delegate or the director of any county board of health, in addition to other procedures now or hereafter provided, may obtain an inspection warrant under the conditions specified in this chapter. Such warrant shall authorize the commissioner of public health or the director of any county board of health, or the agents of any, or the Department of Agriculture, as appropriate, to conduct a search or inspection of property, either with or without the consent of the person whose property is to be searched or inspected, if such search or inspection is one that is elsewhere authorized under the rules and regulations duly promulgated under this title or any provision of law which authorizes licensure, inspection, or regulation by the Department of Public Health or a local agency thereof.

(Code 1933, § 88-302A, enacted by Ga. L. 1975, p. 693, § 1; Ga. L. 1982, p. 1667, §§ 1, 2; Ga. L. 1998, p. 128, § 31; Ga. L. 2009, p. 453, § 1-4/HB 228; Ga. L. 2011, p. 705, § 5-12/HB 214; Ga. L. 2015, p. 598, § 1-12/HB 72.)

Cross references. - Search warrants generally, § 17-5-20 et seq.

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011). For article on the 2015 amendment of this Code section, see 32 Ga. St. U. L. Rev. 63 (2015).

31-5-22. Issuance; grounds.

1. Inspection warrants shall be issued only by a judge of a court of record whose territorial jurisdiction encompasses the property to be inspected.
2. The issuing judge shall issue the warrant when he is satisfied that the following conditions are met:
   1. The one seeking the warrant must establish under oath or affirmation that the property to be inspected is to be inspected as a part of a legally authorized program of inspection which includes that property or that there is probable cause for believing that there is a condition, object, activity, or circumstance which legally justifies such an inspection of that property; and
   2. The issuing judge determines that the issuance of the warrant is authorized by this chapter.

      (Code 1933, §§ 88-303A, 88-304A, enacted by Ga. L. 1975, p. 693, § 1.)

31-5-23. Contents.

The inspection warrant shall be validly issued only if it meets the following requirements:

1. The warrant is attached to the affidavit required to be made in order to obtain the warrant;
2. The warrant describes, either directly or by reference to the affidavit, the property upon which the inspection is to occur and is sufficiently accurate that the executor of the warrant and the owner or possessor of the property can reasonably determine from it the property of which the warrant authorizes an inspection;
3. The warrant indicates the conditions, objects, activities, or circumstances which the inspection is intended to check or reveal; and
4. The warrant refers, in general terms, to the statutory or regulatory provisions sought to be enforced.

   (Code 1933, § 88-305A, enacted by Ga. L. 1975, p. 693, § 1.)

31-5-24. Exclusion of evidence obtained.

Repealed by Ga. L. 2015, p. 598, § 1-13/HB 72, effective July 1, 2015.

Editor's notes. - This Code section was based on Code 1933, § 88-306A, enacted by Ga. L. 1975, p. 693, § 1.

Law reviews. - For article on the 2015 repeal of this Code section, see 32 Ga. St. U. L. Rev. 63 (2015).

31-5A-1 through 31-5A-8.

Editor's notes. - Ga. L. 2009, p. 453, § 1-1/HB 228, effective July 1, 2009, redesignated former Chapter 5A of Title 31 as present Chapter 2 of Title 31.

31-6-1. Declaration of policy.

The policy of this state and the purposes of this chapter are to ensure access to quality health care services and to ensure that health care services and facilities are developed in an orderly and economical manner and are made available to all citizens and that only those health care services found to be in the public interest shall be provided in this state. To achieve such public policy and purposes, it is essential that appropriate health planning activities be undertaken and implemented and that a system of mandatory review of new institutional health services be provided. Health care services and facilities should be provided in a manner that avoids unnecessary duplication of services, that is cost effective, that provides quality health care services, and that is compatible with the health care needs of the various areas and populations of the state.

(Code 1981, § 31-6-1 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 2008, p. 12, § 1-1/SB 433.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2008, the second occurrence of "and" was deleted preceding "purposes, it is essential" in the second sentence.

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

31-6-2. (See Editor's notes.) Definitions.

As used in this chapter, the term:

1. "Ambulatory surgical center or obstetrical facility" means a public or private facility, not a part of a hospital, which provides surgical or obstetrical treatment performed under general or regional anesthesia in an operating room environment to patients not requiring hospitalization.
2. "Application" means a written request for a certificate of need made to the department, containing such documentation and information as the department may require.
3. "Basic perinatal services" means providing basic inpatient care for pregnant women and newborns without complications; managing perinatal emergencies; consulting with and referring to specialty and subspecialty hospitals; identifying high-risk pregnancies; providing follow-up care for new mothers and infants; and providing public/community education on perinatal health.
4. "Bed capacity" means space used exclusively for inpatient care, including space designed or remodeled for inpatient beds even though temporarily not used for such purposes. The number of beds to be counted in any patient room shall be the maximum number for which adequate square footage is provided as established by rules of the department, except that single beds in single rooms shall be counted even if the room contains inadequate square footage.
5. "Board" means the Board of Community Health.
6. "Certificate of need" means an official finding by the department, evidenced by certification issued pursuant to an application, that the action proposed in the application satisfies and complies with the criteria contained in this chapter and rules promulgated pursuant hereto.
7. "Certificate of Need Appeal Panel" or "appeal panel" means the panel of independent hearing officers created pursuant to Code Section 31-6-44 to conduct appeal hearings.
8. "Clinical health services" means diagnostic, treatment, or rehabilitative services provided in a health care facility and includes, but is not limited to, the following: radiology and diagnostic imaging, such as magnetic resonance imaging and positron emission tomography (PET); radiation therapy; biliary lithotripsy; surgery; intensive care; coronary care; pediatrics; gynecology; obstetrics; general medical care; medical-surgical care; inpatient nursing care, whether intermediate, skilled, or extended care; cardiac catheterization; open heart surgery; inpatient rehabilitation; and alcohol, drug abuse, and mental health services.
9. "Commissioner" means the commissioner of community health.
10. "Consumer" means a person who is not employed by any health care facility or provider and who has no financial or fiduciary interest in any health care facility or provider.
11. Reserved.
12. "Department" means the Department of Community Health established under Chapter 2 of this title.
13. "Destination cancer hospital" means an institution with a licensed bed capacity of 50 or less which provides diagnostic, therapeutic, treatment, and rehabilitative care services to cancer inpatients and outpatients, by or under the supervision of physicians, and whose proposed annual patient base is composed of a minimum of 65 percent of patients who reside outside of the State of Georgia.
14. "Develop," with reference to a project, means constructing, remodeling, installing, or proceeding with a project, or any part of a project, or a capital expenditure project, the cost estimate for which exceeds $10 million. Notwithstanding the provisions of this paragraph, the expenditure or commitment or incurring an obligation for the expenditure of funds to develop certificate of need applications, studies, reports, schematics, preliminary plans and specifications, or working drawings or to acquire, develop, or prepare sites shall not be considered to be the developing of a project.
15. "Diagnostic imaging" means magnetic resonance imaging, computed tomography (CT) scanning, positron emission tomography (PET) scanning, positron emission tomography/computed tomography, and other advanced imaging services as defined by the department by rule, but such term shall not include X-rays, fluoroscopy, or ultrasound services.
16. "Diagnostic, treatment, or rehabilitation center" means any professional or business undertaking, whether for profit or not for profit, which offers or proposes to offer any clinical health service in a setting which is not part of a hospital; provided, however, that any such diagnostic, treatment, or rehabilitation center that offers or proposes to offer surgery in an operating room environment and to allow patients to remain more than 23 hours shall be considered a hospital for purposes of this chapter.

    (16.1) "General cancer hospital" means an institution which was an existing and approved destination cancer hospital as of January 1, 2019; has obtained final certificate of need approval for conversion from a destination cancer hospital to a general cancer hospital in accordance with Code Section 31-6-40.3; and offers inpatient and outpatient diagnostic, therapeutic, treatment, and rehabilitative cancer care services or other services to diagnose or treat co-morbid medical conditions or diseases of cancer patients so long as such services do not result in the offering of any new or expanded clinical health service that would require a certificate of need under this chapter unless a certificate of need or letter of determination has been obtained for such new or expanded services.

17. "Health care facility" means hospitals; destination cancer hospitals; other special care units, including but not limited to podiatric facilities; skilled nursing facilities; intermediate care facilities; personal care homes; ambulatory surgical centers or obstetrical facilities; freestanding emergency departments or facilities not located on a hospital's primary campus; health maintenance organizations; home health agencies; and diagnostic, treatment, or rehabilitation centers, but only to the extent paragraph (3) or (7), or both paragraphs (3) and (7), of subsection (a) of Code Section 31-6-40 are applicable thereto.
18. "Health maintenance organization" means a public or private organization organized under the laws of this state which:
    1. Provides or otherwise makes available to enrolled participants health care services, including at least the following basic health care services: usual physicians' services, hospitalization, laboratory, X-ray, emergency and preventive services, and out-of-area coverage;
    2. Is compensated, except for copayments, for the provision of the basic health care services listed in subparagraph (A) of this paragraph to enrolled participants on a predetermined periodic rate basis; and
    3. Provides physicians' services primarily:
       1. Directly through physicians who are either employees or partners of such organization; or
       2. Through arrangements with individual physicians organized on a group practice or individual practice basis.
19. "Health Strategies Council" or "council" means the body created by this chapter to advise the department.
20. "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 places of residence used as such individuals' homes, 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:
    1. Physical therapy;
    2. Occupational therapy;
    3. Speech therapy;
    4. Medical social services under the direction of a physician; or
    5. Part-time or intermittent services of a home health aide.
21. "Hospital" means an institution 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, psychiatric, rehabilitative, geriatric, osteopathic, micro-hospitals, general cancer hospitals, and other specialty hospitals.
22. "Intermediate care facility" 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.
23. "Joint venture ambulatory surgical center" means a freestanding ambulatory surgical center that is jointly owned by a hospital in the same county as the center or a hospital in a  contiguous county if there is no hospital in the same county as the center and a single group of physicians practicing in the center and that provides surgery in a single specialty as defined by the department; provided, however, that general surgery, a group practice which includes one or more physiatrists who perform services that are reasonably related to the surgical procedures performed in the center, and a group practice in orthopedics which includes plastic hand surgeons with a certificate of added qualifications in Surgery of the Hand from the American Board of Plastic and Reconstructive Surgery shall be considered a single specialty. The ownership interest of the hospital shall be no less than 30 percent and the collective ownership of the physicians or group of physicians shall be no less than 30 percent.

    (23.1) "Life plan community" means an organization, whether operated for profit or not, whose owner or operator undertakes to provide shelter, food, and either nursing care or personal services, whether such nursing care or personal services are provided in the facility or in another setting, and other services, as designated by agreement, to an individual not related by consanguinity or affinity to such owner or operator providing such care pursuant to an agreement for a fixed or variable fee, or for any other remuneration of any type, whether fixed or variable, for the period of care, payable in a lump sum, lump sum and monthly maintenance charges or in installments. Agreements to provide continuing care include agreements to provide care for any duration, including agreements that are terminable by either party.

    (23.2) "Micro-hospital" means a hospital in a rural county which has at least two and not more than seven inpatient beds and which provides emergency services seven days per week and 24 hours per day.

24. "New and emerging health care service" means a health care service or utilization of medical equipment which has been developed and has become acceptable or available for implementation or use but which has not yet been addressed under the rules and regulations promulgated by the department pursuant to this chapter.
25. "Nonclinical health services" means services or functions provided or performed by a health care facility, and the parts of the physical plant where they are located in a health care facility that are not diagnostic, therapeutic, or rehabilitative services to patients and are not clinical health services defined in this chapter.
26. "Offer" means that the health care facility is open for the acceptance of patients or performance of services and has qualified personnel, equipment, and supplies necessary to provide specified clinical health services.
27. "Operating room environment" means an environment which meets the minimum physical plant and operational standards specified in the rules of the department which shall consider and use the design and construction specifications as set forth in the Guidelines for Design and Construction of Health Care Facilities published by the American Institute of Architects.
28. "Pediatric cardiac catheterization" means the performance of angiographic, physiologic, and, as appropriate, therapeutic cardiac catheterization on children 14 years of age or younger.
29. "Person" means any individual, trust or estate, partnership, limited liability company or partnership, corporation (including associations, joint-stock companies, and insurance companies), state, political subdivision, hospital authority, or instrumentality (including a municipal corporation) of a state as defined in the laws of this state. This term shall include all related parties, including individuals, business corporations, general partnerships, limited partnerships, limited liability companies, limited liability partnerships, joint ventures, nonprofit corporations, or any other for profit or not for profit entity that owns or controls, is owned or controlled by, or operates under common ownership or control with a person.
30. "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 25 beds and providing, for compensation, protective care and oversight of ambulatory, nonrelated 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 which do not provide personal care.

    (30.1) "Primary campus" means the building at which the majority of a hospital's or a remote location of a hospital's licensed and operational inpatient hospital beds are located, and includes the health care facilities of such hospital within 1,000 yards of such building. Any health care facility operated under a hospital's license prior to July 1, 2019, but not on the hospital's primary campus shall remain part of such hospital but shall not constitute such hospital's primary campus unless otherwise meeting the requirements of this paragraph.

31. "Project" means a proposal to take an action for which a certificate of need is required under this chapter. A project or proposed project may refer to the proposal from its earliest planning stages up through the point at which the new institutional health service is offered.

    (31.1) "Remote location of a hospital" means a hospital facility or organization that is either created by, or acquired by, a hospital that is the main provider for the purpose of furnishing inpatient hospital services under the name, ownership, and financial and administrative control of the main provider.

32. "Rural county" means a county having a population of less than 50,000 according to the United States decennial census of 2010 or any future such census.
33. "Single specialty ambulatory surgical center" means an ambulatory surgical center where surgery is performed in the offices of an individual private physician or single group practice of private physicians if such surgery is performed in a facility that is owned, operated, and utilized by such physicians who also are of a single specialty; provided, however, that general surgery, a group practice which includes one or more physiatrists who perform services that are reasonably related to the surgical procedures performed in the center, and a group practice in orthopedics which includes plastic hand surgeons with a certificate of added qualifications in Surgery of the Hand from the American Board of Plastic and Reconstructive Surgery shall be considered a single specialty.
34. "Skilled nursing facility" 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 injured, disabled, or sick persons.
35. "Specialty hospital" means a hospital that is primarily or exclusively engaged in the care and treatment of one of the following: patients with a cardiac condition, patients with an orthopedic condition, patients receiving a surgical procedure, or patients receiving any other specialized category of services defined by the department. A "specialty hospital" does not include a destination cancer hospital or a general cancer hospital.
36. "State health plan" means a comprehensive program based on recommendations by the Health Strategies Council and the board, approved by the Governor, and implemented by the State of Georgia for the purpose of providing adequate health care services and facilities throughout the state.
37. "Uncompensated indigent or charity care" means the dollar amount of "net uncompensated indigent or charity care after direct and indirect (all) compensation" as defined by, and calculated in accordance with, the department's Hospital Financial Survey and related instructions.
38. "Urban county" means a county having a population equal to or greater than 50,000 according to the United States decennial census of 2010 or any future such census. (Code 1981, § 31-6-2 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1984, p. 22, § 31; Ga. L. 1989, p. 1566, § 1; Ga. L. 1989, p. 1685, § 1; Ga. L. 1991, p. 94, § 31; Ga. L. 1991, p. 1871, §§ 1-5.1; Ga. L. 1991, p. 1880, § 1; Ga. L. 1999, p. 296, §§ 3, 4, 22; Ga. L. 2007, p. 173, § 2A/HB 429; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2009, p. 8, § 31/SB 46; Ga. L. 2009, p. 453, § 1-8/HB 228; Ga. L. 2018, p. 132, § 4/HB 769; Ga. L. 2019, p. 148, § 1-1/HB 186; Ga. L. 2019, p. 945, § 1/HB 300.)

The 2018 amendment, effective July 1, 2018, inserted "micro-hospitals," near the end of paragraph (21); added paragraph (23.1); and substituted "50,000" for "35,000" and "2010" for "2000" in paragraphs (32) and (38).

The 2019 amendments. The first 2019 amendment, effective July 1, 2019, substituted "finding" for "determination" near the beginning of paragraph (6); in paragraph (8), deleted ", or parts of the physical plant where such services are located in a health care facility," following "health care facility" near the middle, inserted "(PET)", substituted "medical-surgical" for "medical/surgical" in the middle, and substituted "open heart" for "open-heart" near the end; substituted the present provisions of paragraph (14) for the former provisions, which read: " 'Develop,' with reference to a project, means:

"(A) Constructing, remodeling, installing, or proceeding with a project, or any part of a project, or a capital expenditure project, the cost estimate for which exceeds $2.5 million; or

"(B) The expenditure or commitment of funds exceeding $1 million for orders, purchases, leases, or acquisitions through other comparable arrangements of major medical equipment; provided, however, that this shall not include build-out costs, as defined by the department, but shall include all functionally related equipment, software, and any warranty and services contract costs for the first five years.

"Notwithstanding subparagraphs (A) and (B) of this paragraph, the expenditure or commitment or incurring an obligation for the expenditure of funds to develop certificate of need applications, studies, reports, schematics, preliminary plans and specifications, or working drawings or to acquire, develop, or prepare sites shall not be considered to be the developing of a project."; added paragraph (16.1); inserted "freestanding emergency departments or facilities not located on a hospital's primary campus;" in the middle of paragraph (17); inserted "general cancer hospitals," near the end of the last sentence of paragraph (21); added paragraphs (30.1) and (31.1); and added "or a general cancer hospital" at the end of the last sentence of paragraph (35). The second 2019 amendment, effective July 1, 2019, substituted "Reserved." for the former provisions of paragraph (11), which read: " 'Continuing care retirement community' means an organization, whether operated for profit or not, whose owner or operator undertakes to provide shelter, food, and either nursing care or personal services, whether such nursing care or personal services are provided in the facility or in another setting, and other services, as designated by agreement, to an individual not related by consanguinity or affinity to such owner or operator providing such care pursuant to an agreement for a fixed or variable fee, or for any other remuneration of any type, whether fixed or variable, for the period of care, payable in a lump sum or lump sum and monthly maintenance charges or in installments. Agreements to provide continuing care include agreements to provide care for any duration, including agreements that are terminable by either party."; added paragraph (23.1); and redesignated former paragraph (23.1) as present paragraph (23.2).

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1990, a misspelling of the first occurrence of "services" in paragraph (15) was corrected.

Pursuant to Code Section 28-9-5, in 2008, in paragraph (17), a semicolon was deleted at the end, and, in paragraph (23), "a contiguous" was substituted for "an contiguous" in the first sentence.

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

For application of this statute in 2020, see Executive Order 05.12.20.02.

A listing of Executive Orders issued in 2020 can be found at https://gov.georgia.gov/executive-action/executive-orders/2020-executive-orders.

31-6-3. "Medical use rights" defined; limitations.

1. As used in this Code section, the term "medical use rights" means rights or interests in real property in which the owner of the property has agreed not to sell or lease such real property for identified medical uses or purposes.
2. It shall be unlawful for any health care facility to purchase, renew, extend, lease, maintain, or hold medical use rights.
3. This Code section shall not be construed to impair any contracts in existence as of July 1, 2019. (Code 1981, § 31-6-3 , enacted by Ga. L. 2019, p. 148, § 1-2/HB 186.)

Effective date. - This Code section became effective July 1, 2019.

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2019, "July 1, 2019" was substituted for "the effective date of this Code section" at the end of subsection (c).

31-6-20. Health Strategies Council generally.

Reserved. Repealed by Ga. L. 2012, p. 1132, § 1/SB 407, effective July 1, 2012.

Editor's notes. - This Code section was based on Code 1981, § 31-6-20 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1984, p. 22, § 31; Ga. L. 1990, p. 1903, § 7; Ga. L. 1991, p. 1880, §§ 2, 3; Ga. L. 1996, p. 6, § 31; Ga. L. 1999, p. 296, §§ 5, 22; Ga. L. 2005, p. 1036, § 24/SB 49; Ga. L. 2007, p. 173, § 2B/HB 429; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2009, p. 8, § 31/SB 46.

31-6-21. Department of Community Health functions and powers.

1. The Department of Community Health, established under Chapter 2 of this title, is authorized to administer the certificate of need program established under this chapter and, within the appropriations made available to the department by the General Assembly of Georgia and consistently with the laws of the State of Georgia, a state health plan adopted by the board. The department shall provide, by rule, for procedures to administer its functions until otherwise provided by the board.
2. The functions of the department shall be:
   1. To conduct the health planning activities of the state and to implement those parts of the state health plan which relate to the government of the state;
   2. To prepare and revise a draft state health plan with recommendations from technical advisory committees;
   3. To seek advice, at its discretion, from technical advisory committees in the performance by the department of its functions pursuant to this chapter;
   4. To adopt, promulgate, and implement rules and regulations sufficient to administer the provisions of this chapter including the certificate of need program;
   5. To define, by rule, the form, content, schedules, and procedures for submission of applications for certificates of need, other determinations, and periodic reports;
   6. To establish time periods and procedures consistent with this chapter to hold hearings and to obtain the viewpoints of interested persons prior to issuance or denial of a certificate of need;
   7. To provide, by rule, for such fees as may be necessary to cover the costs of hearing officers, preparing the record for appeals before such hearing officers and the Certificate of Need Appeal Panel of the decisions of the department, and other related administrative costs, which costs may include reasonable sharing between the department and the parties to appeal hearings;
   8. To establish, by rule, need methodologies for new institutional health services and health care facilities. In developing such need methodologies, the department shall, at a minimum, consider the demographic characteristics of the population, the health status of the population, service use patterns, standards and trends, financial and geographic accessibility, and market economics. The department shall establish service-specific need methodologies and criteria for at least the following clinical health services: short stay hospital beds, adult therapeutic cardiac catheterization, adult open heart surgery, pediatric cardiac catheterization and open heart surgery, Level II and III perinatal services, freestanding birthing centers, psychiatric and substance abuse inpatient programs, skilled nursing and intermediate care facilities, home health agencies, and life plan community sheltered facilities;
   9. To provide, by rule, for a reasonable and equitable fee schedule for certificate of need applications; provided, however, that a certificate of need application filed by or on behalf of a hospital in a rural county shall be exempt from any such fee;
   10. To grant, deny, or revoke a certificate of need as applied for or as amended;
   11. To perform powers and functions delegated by the Governor, which delegation may include the powers to carry out the duties and powers which have been delegated to the department under Section 1122 of the federal Social Security Act of 1935, as amended; and
   12. Study the amount of uncompensated indigent and charity care provided by each type of health care facility, recommend requirements for the levels of uncompensated indigent and charity care required to be performed by each health care facility type and develop standardized reporting requirements for the department to accurately track the amount of uncompensated indigent and charity care provided by each health care facility.
3. The commissioner shall have the power to establish and abolish technical advisory committees as he or she deems necessary, in consultation with the board, to inform effective strategy development and execution. (Code 1981, § 31-6-21 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1984, p. 22, § 31; Ga. L. 1985, p. 829, § 1; Ga. L. 1992, p. 6, § 31; Ga. L. 1994, p. 684, § 1; Ga. L. 1999, p. 296, §§ 6, 22; Ga. L. 2007, p. 173, § 2C/HB 429; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2009, p. 8, § 31/SB 46; Ga. L. 2009, p. 453, § 1-8/HB 228; Ga. L. 2019, p. 148, § 1-3/HB 186; Ga. L. 2019, p. 945, § 2/HB 300.)

The 2019 amendments. The first 2019 amendment, effective July 1, 2019, added "with recommendations from technical advisory committees" at the end of paragraph (b)(2); substituted "technical advisory committees" for "the Health Strategies Council" in paragraph (b)(3); inserted ", other determinations," in paragraph (b)(5); inserted "care" near the end of the first sentence of paragraph (b)(8); added the proviso at the end of paragraph (b)(9); deleted "and" at the end of paragraph (b)(10); substituted "; and" for a period at the end of paragraph (b)(11); and added paragraph (b)(12) and subsection (c). The second 2019 amendment, effective July 1, 2019, substituted "life plan" for "continuing care retirement" near the end of the last sentence of paragraph (b)(8).

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

U.S. Code. - Section 1122 of the federal Social Security Act of 1935, as amended, referred to in paragraph (11), is codified as 42 U.S.C. § 1320a-1.

31-6-21.1. Procedures for rule making by Department of Community Health.

1. Rules of the department shall be adopted, promulgated, and implemented as provided in this Code section and in Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," except that the department shall not be required to comply with subsections (c) through (g) of Code Section 50-13-4.
2. The department shall transmit three copies of the notice provided for in paragraph (1) of subsection (a) of Code Section 50-13-4 to the legislative counsel. The copies shall be transmitted at least 30 days prior to that department's intended action. Within five days after receipt of the copies, if possible, the legislative counsel shall furnish the presiding officer of each house with a copy of the notice and mail a copy of the notice to each member of the Health and Human Services Committee of the Senate and each member of the Health and Human Services Committee of the House of Representatives. Each such rule and any part thereof shall be subject to the making of an objection by either such committee within 30 days of transmission of the rule to the members of such committee. Any rule or part thereof to which no objection is made by both such committees may become adopted by the department at the end of such 30 day period. The department may not adopt any such rule or part thereof which has been changed since having been submitted to those committees unless:
   1. That change is to correct only typographical errors;
   2. That change is approved in writing by both committees and that approval expressly exempts that change from being subject to the public notice and hearing requirements of subsection (a) of Code Section 50-13-4;
   3. That change is approved in writing by both committees and is again subject to the public notice and hearing requirements of subsection (a) of Code Section 50-13-4; or
   4. That change is again subject to the public notice and hearing requirements of subsection (a) of Code Section 50-13-4 and the change is submitted and again subject to committee objection as provided in this subsection.

      Nothing in this subsection shall prohibit the department from adopting any rule or part thereof without adopting all of the rules submitted to the committees if the rule or part so adopted has not been changed since having been submitted to the committees and objection thereto was not made by both committees.

3. Any rule or part thereof to which an objection is made by both committees within the 30 day objection period under subsection (b) of this Code section shall not be adopted by the department and shall be invalid if so adopted. A rule or part thereof thus prohibited from being adopted shall be deemed to have been withdrawn by the department unless the department, within the first 15 days of the next regular session of the General Assembly, transmits written notification to each member of the objecting committees that the department does not intend to withdraw that rule or part thereof but intends to adopt the specified rule or part effective the day following adjournment sine die of that regular session. A resolution objecting to such intended adoption may be introduced in either branch of the General Assembly after the fifteenth day but before the thirtieth day of the session in which occurs the notification of intent not to withdraw a rule or part thereof. In the event the resolution is adopted by the branch of the General Assembly in which the resolution was introduced, it shall be immediately transmitted to the other branch of the General Assembly. It shall be the duty of the presiding officer of the other branch to have that branch, within five days after receipt of the resolution, consider the resolution for purposes of objecting to the intended adoption of the rule or part thereof. Upon such resolution being adopted by two-thirds of the vote of each branch of the General Assembly, the rule or part thereof objected to in that resolution shall be disapproved and not adopted by the department. If the resolution is adopted by a majority but by less than two-thirds of the vote of each such branch, the resolution shall be submitted to the Governor for his or her approval or veto. In the event of a veto, or if no resolution is introduced objecting to the rule, or if the resolution introduced is not approved by at least a majority of the vote of each such branch, the rule shall automatically become adopted the day following adjournment sine die of that regular session. In the event of the Governor's approval of the resolution, the rule shall be disapproved and not adopted by the department.
4. Any rule or part thereof which is objected to by only one committee under subsection (b) of this Code section and which is adopted by the department may be considered by the branch of the General Assembly whose committee objected to its adoption by the introduction of a resolution for the purpose of overriding the rule at any time within the first 30 days of the next regular session of the General Assembly. It shall be the duty of the department in adopting a proposed rule over such objection so to notify the chairpersons of the Health and Human Services Committee of the Senate and the Health and Human Services Committee of the House within ten days after the adoption of the rule. In the event the resolution is adopted by such branch of the General Assembly, it shall be immediately transmitted to the other branch of the General Assembly. It shall be the duty of the presiding officer of the other branch of the General Assembly to have such branch, within five days after the receipt of the resolution, consider the resolution for the purpose of overriding the rule. In the event the resolution is adopted by two-thirds of the votes of each branch of the General Assembly, the rule shall be void on the day after the adoption of the resolution by the second branch of the General Assembly. In the event the resolution is ratified by a majority but by less than two-thirds of the votes of either branch, the resolution shall be submitted to the Governor for his or her approval or veto. In the event of a veto, the rule shall remain in effect. In the event of the Governor's approval, the rule shall be void on the day after the date of approval.
5. Except for emergency rules, no rule or part thereof adopted by the department after April 3, 1985, shall be valid unless adopted in compliance with subsections (b), (c), and (d) of this Code section and subsection (a) of Code Section 50-13-4.
6. Emergency rules shall not be subject to the requirements of subsection (b), (c), or (d) of this Code section but shall be subject to the requirements of subsection (b) of Code Section 50-13-4. Upon the first expiration of any department emergency rules, where those emergency rules are intended to cover matters which had been dealt with by the department's nonemergency rules but such nonemergency rules have been objected to by both legislative committees under this Code section, the emergency rules concerning those matters may not again be adopted except for one 120 day period. No emergency rule or part thereof which is adopted by the department shall be valid unless adopted in compliance with this subsection.
7. Any proceeding to contest any rule on the ground of noncompliance with this Code section must be commenced within two years from the effective date of the rule.
8. For purposes of this Code section, "rules" shall mean rules and regulations.
9. The state health plan or the rules establishing considerations, standards, or similar criteria for the grant or denial of a certificate of need pursuant to Code Section 31-6-42 shall not apply to any application for a certificate of need as to which, prior to the effective date of such plan or rules, respectively, the evidence has been closed following a full evidentiary hearing before a hearing officer.
10. This Code section shall apply only to rules adopted pursuant to this chapter. (Code 1981, § 31-6-21.1 , enacted by Ga. L. 1985, p. 829, § 2; Ga. L. 1986, p. 148, § 1; Ga. L. 1992, p. 6, § 31; Ga. L. 1994, p. 684, § 2; Ga. L. 1999, p. 296, § 22; Ga. L. 2005, p. 48, § 1/HB 309; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2009, p. 453, § 1-23/HB 228.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1985, "April 3, 1985" was substituted for "this Code section becomes effective" in subsection (e).

Pursuant to Code Section 28-9-5, in 1986, a comma was inserted following "1985" in subsection (e).

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

Law reviews. - For annual survey of administrative law, see 57 Mercer L. Rev. 1 (2005). For article, "The Status of Administrative Agencies under the Georgia Constitution," see 40 Ga. L. Rev. 1109 (2006).

31-6-22. Commissioner of department.

Repealed by Ga. L. 2008, p. 12, § 1-1/SB 433, effective July 1, 2008.

Editor's notes. - This Code section was based on Code 1981, § 31-6-22 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1999, p. 296, § 7.

31-6-40. (See Editor's notes.) Certificate of need required for new institutional health services; exemption.

1. On and after July 1, 2008, any new institutional health service shall be required to obtain a certificate of need pursuant to this chapter. New institutional health services include:
   1. The construction, development, or other establishment of a new, expanded, or relocated health care facility, except as otherwise provided in Code Section 31-6-47;
   2. Any expenditure by or on behalf of a health care facility in excess of $10 million which, under generally accepted accounting principles consistently applied, is a capital expenditure, except expenditures for acquisition of an existing health care facility. The dollar amounts specified in this paragraph and in paragraph (14) of Code Section 31-6-2 shall be adjusted annually by an amount calculated by multiplying such dollar amounts (as adjusted for the preceding year) by the annual percentage of change in the composite index of construction material prices, or its successor or appropriate replacement index, if any, published by the United States Department of Commerce for the preceding calendar year, commencing on July 1, 2019, and on each anniversary thereafter of publication of the index. The department shall immediately institute rule-making procedures to adopt such adjusted dollar amounts. In calculating the dollar amounts of a proposed project for purposes of this paragraph and paragraph (14) of Code Section 31-6-2, the costs of all items subject to review by this chapter and items not subject to review by this chapter associated with and simultaneously developed or proposed with the project shall be counted, except for the expenditure or commitment of or incurring an obligation for the expenditure of funds to develop certificate of need applications, studies, reports, schematics, preliminary plans and specifications or working drawings, or to acquire sites;
   3. The purchase or lease by or on behalf of a health care facility or a diagnostic, treatment, or rehabilitation center of diagnostic or therapeutic equipment, except as otherwise provided in Code Section 31-6-47;
   4. Any increase in the bed capacity of a health care facility except as provided in Code Section 31-6-47;
   5. Clinical health services which are offered in or through a health care facility, which were not offered on a regular basis in or through such health care facility within the 12 month period prior to the time such services would be offered;
   6. Any conversion or upgrading of any general acute care hospital to a specialty hospital or of a facility such that it is converted from a type of facility not covered by this chapter to any of the types of health care facilities which are covered by this chapter;
   7. Clinical health services which are offered in or through a diagnostic, treatment, or rehabilitation center which were not offered on a regular basis in or through that center within the 12 month period prior to the time such services would be offered, but only if the clinical health services are any of the following:
      1. Radiation therapy;
      2. Biliary lithotripsy;
      3. Surgery in an operating room environment, including but not limited to ambulatory surgery; and
      4. Cardiac catheterization; and
   8. The conversion of a destination cancer hospital to a general cancer hospital.
2. Any person proposing to develop or offer a new institutional health service or health care facility shall, before commencing such activity, submit a letter of intent and an application to the department and obtain a certificate of need in the manner provided in this chapter unless such activity is excluded from the scope of this chapter.
3. 1. Any person who had a valid exemption granted or approved by the former Health Planning Agency or the department prior to July 1, 2008, shall not be required to obtain a certificate of need in order to continue to offer those previously offered services.
   2. Any facility offering ambulatory surgery pursuant to the exclusion designated on June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2; any diagnostic, treatment, or rehabilitation center offering diagnostic imaging or other imaging services in operation and exempt prior to July 1, 2008; or any facility operating pursuant to a letter of nonreviewability and offering diagnostic imaging services prior to July 1, 2008, shall:
      1. Provide annual reports in the same manner and in accordance with Code Section 31-6-70; and
      2. 1. Provide care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids beneficiaries and provide uncompensated indigent and charity care in an amount equal to or greater than 2 percent of its adjusted gross revenue; or
         2. If the facility is not a participant in Medicaid or the PeachCare for Kids Program, provide uncompensated care for Medicaid beneficiaries and, if the facility provides medical care and treatment to children, for PeachCare for Kids beneficiaries, uncompensated indigent and charity care, or both in an amount equal to or greater than 4 percent of its adjusted gross revenue if it:
            1. Makes a capital expenditure associated with the construction, development, expansion, or other establishment of a clinical health service or the acquisition or replacement of diagnostic or therapeutic equipment with a value in excess of $800,000.00 over a two-year period;
            2. Builds a new operating room; or
            3. Chooses to relocate in accordance with Code Section 31-6-47.

               Noncompliance with any condition of this paragraph shall result in a monetary penalty in the amount of the difference between the services which the center is required to provide and the amount actually provided and may be subject to revocation of its exemption status by the department for repeated failure to pay any fees or moneys due to the department or for repeated failure to produce data as required by Code Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act." The dollar amount specified in this paragraph shall be adjusted annually by an amount calculated by multiplying such dollar amount (as adjusted for the preceding year) by the annual percentage of change in the consumer price index, or its successor or appropriate replacement index, if any, published by the United States Department of Labor for the preceding calendar year, commencing on July 1, 2009. In calculating the dollar amounts of a proposed project for the purposes of this paragraph, the costs of all items subject to review by this chapter and items not subject to review by this chapter associated with and simultaneously developed or proposed with the project shall be counted, except for the expenditure or commitment of or incurring an obligation for the expenditure of funds to develop certificate of need applications, studies, reports, schematics, preliminary plans and specifications or working drawings, or to acquire sites. Subparagraph (B) of this paragraph shall not apply to facilities offering ophthalmic ambulatory surgery pursuant to the exclusion designated on June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2 that are owned by physicians in the practice of ophthalmology.

4. A certificate of need issued to a destination cancer hospital shall authorize the beds and all new institutional health services of such destination cancer hospital. As used in this subsection, the term "new institutional health service" shall have the same meaning provided for in subsection (a) of this Code section. A certificate of need shall only be issued to a destination cancer hospital that locates itself and all affiliated facilities within 25 miles of a commercial airport in this state with five or more runways. Such destination cancer hospital shall not be required to apply for or obtain additional certificates of need for new institutional health services related to the treatment of cancer patients, and such new institutional health services related to the treatment of cancer patients offered by the destination cancer hospital shall not be reviewed under any service-specific need methodology or rules except for those promulgated by the department for destination cancer hospitals. After commencing operations, in order to add an additional new institutional health service, a destination cancer hospital shall apply for and obtain an additional certificate of need under the applicable statutory provisions and any rules promulgated by the department for destination cancer hospitals, and such applications shall only be granted if the patient base of such destination cancer hospital is composed of at least 65 percent of out-of-state patients for two consecutive years. The department may apply rules for a destination cancer hospital only for those services that the department determines are to be used by the destination cancer hospital in connection with the treatment of cancer. In no case shall destination cancer hospital specific rules be used in the case of an application for open heart surgery, perinatal services, cardiac catheterization, and other services deemed by the department to be not reasonably related to the diagnosis and treatment of cancer; provided, however, that the department shall apply the destination cancer hospital specific rules if a destination cancer hospital applies for services and equipment required for it to meet federal or state laws applicable to a hospital. If such destination cancer hospital cannot show a patient base of a minimum of 65 percent from outside of this state, then its application for any new institutional health service shall be evaluated under the specific statutes and rules applicable to that particular service. If such destination cancer hospital applies for a certificate of need to add an additional new institutional health service before commencing operations or completing two consecutive years of operation, such applicant may rely on historical data from its affiliated entities, as set forth in paragraph (2) of subsection (b.1) of Code Section 31-6-42. Because destination cancer hospitals provide services primarily to out-of-state residents, the number of beds, services, and equipment destination cancer hospitals use shall not be counted as part of the department's inventory when determining the need for those items by other providers. No person shall be issued more than one certificate of need for a destination cancer hospital. Nothing in this Code section shall in any way require a destination cancer hospital to obtain a certificate of need for any purpose that is otherwise exempt from the certificate of need requirement. Beginning January 1, 2010, the department shall not accept any application for a certificate of need for a new destination cancer hospital; provided, however, all other provisions regarding the upgrading, replacing, or purchasing of diagnostic or therapeutic equipment shall be applicable to an existing destination cancer hospital.
5. The commissioner shall be authorized, with the approval of the board, to place a temporary moratorium of up to six months on the issuance of certificates of need for new and emerging health care services. Any such moratorium placed shall be for the purpose of promulgating rules and regulations regarding such new and emerging health care services. A moratorium may be extended one time for an additional three months if circumstances warrant, as approved by the board. In the event that final rules and regulations are not promulgated within the time period allowed by the moratorium, any applications received by the department for a new and emerging health care service shall be reviewed under existing general statutes and regulations relating to certificates of need. (Code 1981, § 31-6-40 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1991, p. 1871, § 6; Ga. L. 1999, p. 296, § 22; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2009, p. 8, § 31/SB 46; Ga. L. 2019, p. 148, § 1-4/HB 186.)

The 2019 amendment, effective July 1, 2019, rewrote subsection (a); deleted former subparagraph (c)(2)(A), which read: "Provide notice to the department of the name, ownership, location, single specialty, and services provided in the exempt facility;"; substituted "(A) Provide" for "(B) Beginning on January 1, 2009, provide"; redesignated former subparagraph (c)(2)(C) as present subparagraph (c)(2)(B); and substituted "Subparagraph (B)" for "Subparagraph (C)" at the beginning of the last sentence of the undesignated paragraph of subparagraph (c)(2)(B).

Cross references. - Licensed hospice exempt from certificate of need requirement, § 31-7-179 .

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2008, "a" was deleted following "no case shall" in the seventh sentence of subsection (d).

Editor's notes. - By resolution (Ga. L. 1990, p. 970), the General Assembly directed the State Health Planning Agency to make certain studies and reports and to update its rules and regulations.

Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

For application of this statute in 2020, see Executive Order 03.20.20.02.

A listing of Executive Orders issued in 2020 can be found at https://gov.georgia.gov/executive-action/executive-orders/2020-executive-orders.

Law reviews. - For annual survey on administrative law, see 69 Mercer L. Rev. 15 (2017). For annual survey on administrative law, see 70 Mercer L. Rev. 1 (2018).

31-6-40.1. Acquisition of health care facilities; penalty for failure to notify department; limitation on applications; agreement to care for indigent patients; requirements for destination cancer hospitals; notice and hearing provisions for penalties authorized.

1. Any person who acquires a health care facility by stock or asset purchase, merger, consolidation, or other lawful means shall notify the department of such acquisition, the date thereof, and the name and address of the acquiring person. Such notification shall be made in writing to the department within 45 days following the acquisition and the acquiring person may be fined by the department in the amount of $500.00 for each day that such notification is late. Such fine shall be paid into the state treasury.
2. The department may limit the time periods during which it will accept applications for the following health care facilities:
   1. Skilled nursing facilities;
   2. Intermediate care facilities; and
   3. Home health agencies,

      to only such times after the department has determined there is an unmet need for such facilities. The department shall make a determination as to whether or not there is an unmet need for each type of facility at least every six months and shall notify those requesting such notification of that determination.

3. The department may require that any applicant for a certificate of need agree to provide a specified amount of clinical health services to indigent patients as a condition for the grant of a certificate of need; provided, however, that each facility granted a certificate of need by the department as a destination cancer hospital shall be required to provide uncompensated indigent or charity care for residents of Georgia which meets or exceeds 3 percent of such destination cancer hospital's adjusted gross revenues and provide care to Medicaid beneficiaries. A grantee or successor in interest of a certificate of need or an authorization to operate under this chapter which violates such an agreement or violates any conditions imposed by the department relating to such services, whether made before or after July 1, 2008, shall be liable to the department for a monetary penalty in the amount of the difference between the amount of services so agreed to be provided and the amount actually provided and may be subject to revocation of its certificate of need, in whole or in part, by the department pursuant to Code Section 31-6-45. Any penalty so recovered shall be paid into the state treasury.

   (c.1) (1) A destination cancer hospital that does not meet an annual patient base composed of a minimum of 65 percent of patients who reside outside this state in a calendar year shall be fined $2 million for the first year of noncompliance, $4 million for the second consecutive year of noncompliance, and $6 million for the third consecutive year of noncompliance. Such fine amount shall reset to $2 million after any year of compliance. In the event that a destination cancer hospital does not meet an annual patient base composed of a minimum of 65 percent of patients who reside outside this state for three calendar years in any five-year period, such hospital shall be fined an additional amount of $8 million. It is the intent of the General Assembly that all revenues collected from any such fines shall be dedicated and deposited by the department into the Indigent Care Trust Fund created pursuant to Code Section 31-8-152.

   (2) In the event a certificate of need for a destination cancer hospital is revoked pursuant to this subsection, such hospital shall be subject to fines pursuant to subsection (c) of Code Section 31-6-45 for operating without a certificate of need.

   (3) In addition to the annual report required pursuant to Code Section 31-6-70, a destination cancer hospital shall submit an annual statement, in accordance with timeframes and a format specified by the department, affirming that the hospital has met an annual patient base composed of a minimum of 65 percent of patients who reside outside this state. The chief executive officer of the destination cancer hospital shall certify under penalties of perjury that the statement as prepared accurately reflects the composition of the annual patient base. The department shall have the authority to inspect any books, records, papers, or other information pursuant to subsection (e) of Code Section 31-6-45 of the destination cancer hospital to confirm the information provided on such statement or any other information required of the destination cancer hospital. Nothing in this paragraph shall be construed to require the release of any information which would violate the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191.

4. Penalties authorized under this Code section shall be subject to the same notices and hearing for the levy of fines under Code Section 31-6-45 . (Code 1981, § 31-6-40.1 , enacted by Ga. L. 1991, p. 1419, § 1; Ga. L. 1999, p. 296, § 22; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2009, p. 8, § 31/SB 46; Ga. L. 2019, p. 148, § 1-5/HB 186.)

The 2019 amendment, effective July 1, 2019, deleted former subsection (b.1), which read: "The department may establish, by rule, set times during the year in which applications for capital projects exceeding the threshold amounts in:

"(1) Paragraph (14) of Code Section 31-6-2; and

"(2) Paragraph (2) or (3) of subsection (a) of Code Section 31-6-40 shall be accepted."

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

31-6-40.2. New perinatal services.

1. As used in this Code section only, the term:
   1. "Certificate of need application" means an application for a certificate of need filed with the department, any amendments thereto, and any other written material relating to the application and filed by the applicant with the department.
   2. "First three years of operation" means the first three consecutive 12 month periods beginning on the first day of a new perinatal service's first full calendar month of operation.
   3. "First year of operation" means the first consecutive 12 month period beginning on the first day of a new perinatal service's first full calendar month of operation.
   4. "New perinatal service" means a perinatal service whose first year of operation ends after April 6, 1992.
   5. "Perinatal service" means obstetric and neonatal services relating to managing high-risk pregnancies, care for moderately ill newborns, care for all maternal and fetal complications either on site or by referral, and operation of neonatal intensive care units equipped to treat critically ill newborns; provided however, this shall not include basic perinatal services as defined in Code Section 31-6-2.
   6. "Year" means one of the three consecutive 12 month periods in a new perinatal service's first 36 months of operation.
2. 1. A new perinatal service shall provide uncompensated indigent or charity care in an amount which meets or exceeds the department's established minimum at the time the department issued the certificate of need approval for such service for each of the service's first three years of operation; provided, however, that if the certificate of need application under which a new perinatal service was approved included a commitment that uncompensated indigent or charity care would be provided in an amount greater than the established minimum for any time period described in the certificate of need application that falls completely within such new perinatal service's first three years of operation, such new perinatal service shall provide indigent or charity care in an amount which meets or exceeds the amount committed in the certificate of need application for each time period described in the certificate of need application that falls completely within the service's first three years of operation.
   2. The department shall revoke the certificate of need and authority to operate of a new perinatal service if after notice to the grantee of the certificate or such grantee's successors, and after opportunity for a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," the department determines that such new perinatal service has failed to provide indigent or charity care in accordance with the requirements of paragraph (1) of this subsection and such failure is determined by the department to be for reasons substantially within the perinatal service provider's control. The department shall provide the requisite notice, conduct the fair hearing, if requested, and render its determination within 90 days after the end of the first year, or, if applicable, the first time period described in paragraph (1) of this subsection during which the new perinatal service fails to provide indigent or charity care in accordance with the requirements of paragraph (1) of this subsection. Revocation shall be effective 30 days after the date of the determination by the department that the requirements of paragraph (1) of this subsection have not been met.
3. 1. A new perinatal service shall achieve the standard number of births specified in the state health plan in effect at the time of the issuance of the certificate of need approval by the department in at least one year during its first three years of operation.
   2. The department shall revoke the certificate of need and authority to operate of a new perinatal service if after notice to the grantee of the certificate of need or such grantee's successors, and after opportunity for a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," the department determines that such new perinatal service has failed to comply with the applicable requirements of paragraph (1) of this subsection and such failure is determined by the department to be for reasons substantially within the perinatal service provider's control. The department shall provide the requisite notice, conduct the fair hearing, if requested, and render its determination within 90 days after the end of the new perinatal service's first three years of operation. Revocation shall be effective 30 days after the date of the determination by the department that the requirements of this paragraph or paragraph (1) of this subsection have not been met.
4. Nothing contained in this Code section shall limit the department's authority to regulate perinatal services in ways or for time periods not addressed by the provisions of this Code section. (Code 1981, § 31-6-40.2 , enacted by Ga. L. 1992, p. 1068, § 1; Ga. L. 1999, p. 296, § 22; Ga. L. 2008, p. 12, § 1-1/SB 433.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1992, "April 6, 1992" was substituted for "the date this Code Section becomes effective" in paragraph (a)(4), and "this paragraph or paragraph (1)" was substituted for "paragraph (1) or (2)" in the last sentence of paragraph (c)(2).

Pursuant to Code Section 28-9-5, in 2008, "service's" was substituted for "service" in paragraph (a)(6).

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

Law reviews. - For note on 1992 enactment of this Code section, see 9 Ga. St. U. L. Rev. 265 (1992).

31-6-40.3. Conversion of destination cancer hospital to general cancer hospital; procedure; requirements.

1. On and after July 1, 2019, a destination cancer hospital may apply for a certificate of need to convert to a general cancer hospital in accordance with this Code section. A destination cancer hospital that elects to convert to a general cancer hospital shall notify the department in a form and manner established by the department.
2. The department shall establish a form and process for a destination cancer hospital to submit a certificate of need application to convert to a general cancer hospital; provided, however, that such a conversion shall not be subject to any of the considerations in Code Section 31-6-42 or service specific rules and shall not be subject to opposition or appeal by any other health care facilities. The department shall develop such form and guidance required by this subsection within 30 days of July 1, 2019. Upon its receipt of a complete application for a destination cancer hospital to convert to a general cancer hospital, the department shall issue such certificate of need within 60 days.
3. Upon the conversion of a destination cancer hospital to a general cancer hospital:
   1. The general cancer hospital may continue to provide all institutional health care services and other services it provided as of the date of such conversion, including but not limited to inpatient beds, outpatient services, surgery, radiation therapy, imaging, and positron emission tomography (PET) scanning, without any further approval from the department;
   2. The destination cancer hospital shall be classified as a general cancer hospital under this chapter and shall be subject to all requirements and conditions applicable to hospitals under this article, including but not limited to, indigent and charity care and inventories and methodologies to determine need for additional providers or services; and
   3. The hospital's inpatient beds, operating rooms, radiation therapy equipment, and imaging equipment existing on the date of conversion shall not be counted in the inventory by the department for purposes of determining need for additional providers or services, except that any inpatient beds, operating rooms, radiation therapy equipment, and imaging equipment added after the date of conversion shall be counted in accordance with the department's rules and regulations.
4. In the event that a destination cancer hospital does not convert to a general cancer hospital, it shall remain subject to all requirements and conditions applicable to destination cancer hospitals under this article. (Code 1981, § 31-6-40.3 , enacted by Ga. L. 2019, p. 148, § 1-6/HB 186.)

Effective date. - This Code section became effective July 1, 2019.

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2019, "July 1, 2019" was substituted for "the effective date of this Act" at the end of the second sentence in subsection (b).

31-6-41. Scope and term of validity of certificate.

1. A certificate of need shall be valid only for the defined scope, location, cost, service area, and person named in an application, as it may be amended, and as such scope, location, service area, cost, and person are approved by the department, unless such certificate of need owned by an existing health care facility is transferred to a person who acquires such existing facility. In such case, the certificate of need shall be valid for the person who acquires such a facility and for the scope, location, cost, and service area approved by the department. However, in reviewing an application to relocate all or a portion of an existing skilled nursing facility, intermediate care facility, or intermingled nursing facility, the department may allow such facility to divide into two or more such facilities if the department determines that the proposed division is financially feasible and would be consistent with quality patient care.
2. A certificate of need shall be valid and effective for a period of 12 months after it is issued, or such greater period of time as may be specified by the department at the time the certificate of need is issued. Within the effective period after the grant of a certificate of need, the applicant of a proposed project shall fulfill reasonable performance and scheduling requirements specified by the department, by rule, to assure reasonable progress toward timely completion of a project.
3. By rule, the department may provide for extension of the effective period of a certificate of need when an applicant, by petition, makes a good faith showing that the conditions to be specified according to subsection (b) of this Code section will be performed within the extended period and that the reasons for the extension are beyond the control of the applicant. (Code 1981, § 31-6-41 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1999, p. 296, § 22; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2009, p. 8, § 31/SB 46.)

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

31-6-42. Qualifications for issuance of certificate.

1. The written findings of fact and decision, with respect to the department's grant or denial of a certificate of need, shall be based on the applicable considerations specified in this Code section and reasonable rules promulgated by the department interpretive thereof. The department shall issue a certificate of need to each applicant whose application is consistent with the following considerations and such rules deemed applicable to a project, except as specified in subsection (f) of Code Section 31-6-43:
   1. The proposed new institutional health services are reasonably consistent with the relevant general goals and objectives of the state health plan;
   2. The population residing in the area served, or to be served, by the new institutional health service has a need for such services;
   3. 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;
   4. The project can be adequately financed and is, in the immediate and long term, financially feasible;
   5. The effects of new institutional health service on payors for health services, including governmental payors, are not unreasonable;
   6. 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;
   7. The new institutional health service proposed is reasonably financially and physically accessible to the residents of the proposed service area;
   8. The proposed new institutional health service has a positive relationship to the existing health care delivery system in the service area;
   9. The proposed new institutional health service encourages more efficient utilization of the health care facility proposing such service;
   10. 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;
   11. The proposed new institutional health service conducts biomedical or behavioral research projects or new service development which is designed to meet a national, regional, or state-wide need;
   12. The proposed new institutional health service meets the clinical needs of health professional training programs which request assistance;
   13. The proposed new institutional health service fosters improvements or innovations in the financing or delivery of health services, promotes health care quality assurance or cost effectiveness, or fosters competition that is shown to result in lower patient costs without a loss of the quality of care;
   14. The proposed new institutional health service fosters the special needs and circumstances of health maintenance organizations;
   15. 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;
   16. The proposed new institutional health service can obtain the necessary resources, including health care personnel and management personnel; and
   17. 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.
2. In the case of applications for the development or offering of a new institutional health service or health care facility for osteopathic medicine, the need for such service or facility shall be determined on the basis of the need and availability in the community for osteopathic services and facilities in addition to the considerations in subsection (a) of this Code section. Nothing in this chapter shall, however, be construed as otherwise recognizing any distinction between allopathic and osteopathic medicine.

   (b.1) In the case of applications for the construction, development, or establishment of a destination cancer hospital, the applicable considerations as to the need for such service shall not include paragraphs (1), (2), (3), (7), (8), (10), (11), and (14) of subsection (a) of this Code section but shall include:

   (b.2) In the case of applications for basic perinatal services in counties where:

   1. Paragraphs (4), (5), (6), (9), (12), (13), (15), (16), and (17) of subsection (a) of this Code section;
   2. That the proposed new destination cancer hospital can demonstrate, based on historical data from the applicant or its affiliated entities, that its annual patient base shall be composed of a minimum of 65 percent of patients who reside outside of the State of Georgia;
   3. That the proposed new destination cancer hospital states its intent to provide uncompensated indigent or charity care which shall meet or exceed 3 percent of its adjusted gross revenues and provide care to Medicaid beneficiaries;
   4. That the proposed new destination cancer hospital shall conduct biomedical or behavioral research projects or service development which is designed to meet a national or regional need;
   5. That the proposed new destination cancer hospital shall be reasonably financially and physically accessible;
   6. That the proposed new destination cancer hospital shall have a positive relationship to the existing health care delivery system on a regional basis;

      (6.1) That the proposed new destination cancer hospital shall enter into a hospital transfer agreement with one or more hospitals within a reasonable distance from the destination cancer hospital or the medical staff at the destination cancer hospital has admitting privileges or other acceptable documented arrangements with such hospital or hospitals to ensure the necessary backup for the destination cancer hospital for medical complications. The destination cancer hospital shall have the capability to transfer a patient immediately to a hospital within a reasonable distance from the destination cancer hospital with adequate emergency room services. Hospitals shall not unreasonably deny a transfer agreement with the destination cancer hospital. In the event that a destination cancer hospital and another hospital cannot agree to the terms of a transfer agreement as required by this paragraph, the department shall mediate between such parties for a period of no more than 45 days. If an agreement is still not reached within such 45 day period, the parties shall enter into binding arbitration conducted by the department;

   7. That an applicant for a new destination cancer hospital shall document in its application that the new facility is not predicted to be detrimental to existing hospitals within the planning area. Such demonstration shall be made by providing an analysis in such application that compares current and projected changes in market share and payor mix for such applicant and such existing hospitals within the planning area. Impact on an existing hospital shall be determined to be adverse if, based on the utilization projected by the applicant, such existing hospital would have a total decrease of 10 percent or more in its average annual utilization, as measured by patient days for the two most recent and available preceding calendar years of data; and
   8. That the destination cancer hospital shall express its intent to participate in medical staffing work force development activities.

      (1) Only one civilian health care facility or health system is currently providing basic perinatal services; and

      (2) There are not at least three different health care facilities in a contiguous county providing basic perinatal services,

      the department shall not apply the consideration contained in paragraph (2) of subsection (a) of this Code section.

3. If the denial of an application for a certificate of need for a new institutional health service proposed to be offered or developed by a:
   1. Minority administered hospital facility serving a socially and economically disadvantaged minority population in an urban setting; or
   2. Minority administered hospital facility utilized for the training of minority medical practitioners

      would adversely impact upon the facility and population served by said facility, the special needs of such hospital facility and the population served by said facility for the new institutional health service shall be given extraordinary consideration by the department in making its determination of need as required by this Code section. The department shall have the authority to vary or modify strict adherence to the provisions of this chapter and the rules enacted pursuant hereto in considering the special needs of such facility and its population served and to avoid an adverse impact on the facility and the population served thereby. For purposes of this subsection, the term "minority administered hospital facility" means a hospital controlled or operated by a governing body or administrative staff composed predominantly of members of a minority race.

4. For the purposes of the considerations contained in this Code section and in the department's applicable rules, relevant data which were unavailable or omitted when the state health plan or rules were prepared or revised may be considered in the evaluation of a project.
5. The department shall specify in its written findings of fact and decision which of the considerations contained in this Code section and the department's applicable rules are applicable to an application and its reasoning as to and evidentiary support for its evaluation of each such applicable consideration and rule. (Code 1981, § 31-6-42 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1984, p. 22, § 31; Ga. L. 1999, p. 296, § 22; Ga. L. 2008, p. 12, § 1-1/SB 433.)

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

Law reviews. - For annual survey on administrative law, see 64 Mercer L. Rev. 39 (2012).

31-6-42.1. Payment of obligations prior to granting or modifying a certificate of need.

No applicant for a new certificate of need, a modification to an existing certificate of need, or a conversion of a certificate of need that has any outstanding amounts owed to the state including fines, penalties, fees, or other payments for noncompliance with any requirements contained in Code Section 31-6-40.1, 31-6-45.2, 31-6-70, 31-7-280, or 31-8-179.2 shall be eligible to receive a new certificate of need or a modification to an existing certificate of need unless such applicant pays such outstanding amounts to the state. Any such fines, penalties, fees, or other payments for noncompliance shall be subject to the same notices and hearing for the levy of fines under Code Section 31-6-45.

(Code 1981, § 31-6-42.1 , enacted by Ga. L. 2019, p. 148, § 1-7/HB 186.)

Effective date. - This Code section became effective July 1, 2019.

31-6-43. Acceptance or rejection of application for certificate.

1. At least 30 days prior to submitting an application for a certificate of need for clinical health services, a person shall submit a letter of intent to the department. The department shall provide by rule a process for submitting letters of intent and a mechanism by which applications may be filed to compete with and be reviewed comparatively with proposals described in submitted letters of intent.
2. Each application for a certificate of need shall be reviewed by the department and within ten working days after the date of its receipt a determination shall be made as to whether the application complies with the rules governing the preparation and submission of applications. If the application complies with the rules governing the preparation and submission of applications, the department shall declare the application complete for review, shall accept and date the application, and shall notify the applicant of the timetable for its review. The department shall also notify a newspaper of general circulation in the county in which the project shall be developed that the application has been deemed complete. The department shall also notify the appropriate regional commission and the chief elected official of the county and municipal governments, if any, in whose boundaries the proposed project will be located that the application is complete for review. If the application does not comply with the rules governing the preparation and submission of applications, the department shall notify the applicant in writing and provide a list of all deficiencies. The applicant shall be afforded an opportunity to correct such deficiencies, and upon such correction, the application shall then be declared complete for review within ten days of the correction of such deficiencies, and notice given to a newspaper of general circulation in the county in which the project shall be developed that the application has been so declared. The department shall also notify the appropriate regional commission and the chief elected official of the county and municipal governments, if any, in whose boundaries the proposed project will be located that the application is complete for review or when in the determination of the department a significant amendment is filed.
3. The department shall specify by rule the time within which an applicant may amend its application. The department may request an applicant to make amendments. The department decision shall be made on an application as amended, if at all, by the applicant.
4. 1. There shall be a time limit of 120 days for review of a project, beginning on the day the department declares the application complete for review or in the case of applications joined for comparative review, beginning on the day the department declares the final application complete. The department may adopt rules for determining when it is not practicable to complete a review in 120 days and may extend the review period upon written notice to the applicant but only for an extended period of not longer than an additional 30 days. The department shall adopt rules governing the submission of additional information by the applicant and for opposing an application.
   2. No party may oppose an application for a certificate of need for a proposed project unless:
      1. Such party offers substantially similar services as proposed within a 35 mile radius of the proposed project or has a service area that overlaps the applicant's proposed service area; or
      2. Such party has submitted a competing application in the same batching cycle and is proposing to establish the same type of facility proposed or offers substantially similar services as proposed and has a service area that overlaps the applicant's proposed service area.
5. To allow the opportunity for comparative review of applications, the department may provide by rule for applications for a certificate of need to be submitted on a timetable or batching cycle basis no less often than two times per calendar year for each clinical health service. Applications for services, facilities, or expenditures for which there is no specified batching cycle may be filed at any time.
6. The department may order the joinder of an application which is determined to be complete by the department for comparative review with one or more subsequently filed applications declared complete for review during the same batching cycle when:
   1. The first and subsequent applications involve similar clinical health service projects in the same service area or overlapping service areas; and
   2. The subsequent applications are filed and are declared complete for review within 30 days of the date the first application was declared complete for review.

      Following joinder of the first application with subsequent applications, none of the subsequent applications so joined may be considered as a first application for the purposes of future joinder. The department shall notify the applicant to whose application a joinder is ordered and all other applicants previously joined to such application of the fact of each joinder pursuant to this subsection. In the event one or more applications have been joined pursuant to this subsection, the time limits for department action for all of the applicants shall run from the latest date that any one of the joined applications was declared complete for review. In the event of the consideration of one or more applications joined pursuant to this subsection, the department may award no certificate of need or one or more certificates of need to the application or applications, if any, which are consistent with the considerations contained in Code Section 31-6-42, the department's applicable rules, and the award of which will best satisfy the purposes of this chapter.

7. The department shall review the application and all written information submitted by the applicant in support of the application and all information submitted in opposition to the application to determine the extent to which the proposed project is consistent with the applicable considerations stated in Code Section 31-6-42 and in the department's applicable rules. During the course of the review, the department staff may request additional information from the applicant as deemed appropriate. Pursuant to rules adopted by the department, a public hearing on applications covered by those regulations may be held prior to the date of the department's decision thereon. Such rules shall provide that when good cause has been shown, a public hearing shall be held by the department. Any interested person may submit information to the department concerning an application, and an applicant shall be entitled to notice of and to respond to any such submission.
8. The department shall provide the applicant an opportunity to meet with the department to discuss the application and to provide an opportunity to submit additional information. Such additional information shall be submitted within the time limits adopted by the department. The department shall also provide an opportunity for any party that is permitted to oppose an application pursuant to paragraph (2) of subsection (d) of this Code section to meet with the department and to provide additional information to the department. In order for any such opposing party to have standing to appeal an adverse decision pursuant to Code Section 31-6-44, such party must attend and participate in an opposition meeting.
9. Unless extended by the department for an additional period of up to 30 days pursuant to subsection (d) of this Code section, the department shall, no later than 120 days after an application is determined to be complete for review, or, in the event of joined applications, 120 days after the last application is declared complete for review, provide written notification to an applicant of the department's decision to issue or to deny issuance of a certificate of need for the proposed project. Such notice shall contain the department's written findings of fact and decision as to each applicable consideration or rule and a detailed statement of the reasons and evidentiary support for issuing or denying a certificate of need for the action proposed by each applicant. The department shall also mail such notification to the appropriate regional commission and the chief elected official of the county and municipal governments, if any, in whose boundaries the proposed project will be located. In the event such decision is to issue a certificate of need, the certificate of need shall be effective on the day of the decision unless the decision is appealed to the Certificate of Need Appeal Panel in accordance with this chapter. Within seven days of the decision, the department shall publish notice of its decision to grant or deny an application in the same manner as it publishes notice of the filing of an application.
10. Should the department fail to provide written notification of the decision within the time limitations set forth in this Code section, an application shall be deemed to have been approved as of the one hundred twenty-first day following notice from the department that an application, or the last of any applications joined pursuant to subsection (f) of this Code section, is declared "complete for review."
11. Notwithstanding other provisions of this article, when the Governor has declared a state of emergency in a region of the state, existing health care facilities in the affected region may seek emergency approval from the department to make expenditures in excess of the capital expenditure threshold or to offer services that may otherwise require a certificate of need. The department shall give special expedited consideration to such requests and may authorize such requests for good cause. Once the state of emergency has been lifted, any services offered by an affected health care facility under this subsection shall cease to be offered until such time as the health care facility that received the emergency authorization has requested and received a certificate of need. For purposes of this subsection, "good cause" means that authorization of the request shall directly resolve a situation posing an immediate threat to the health and safety of the public. The department shall establish, by rule, procedures whereby requirements for the process of review and issuance of a certificate of need may be modified and expedited as a result of emergency situations. (Code 1981, § 31-6-43 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1984, p. 22, § 31; Ga. L. 1989, p. 1317, §§ 6.15, 6.16; Ga. L. 1999, p. 296, § 22; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2008, p. 181, § 15/HB 1216; Ga. L. 2012, p. 775, § 31/HB 942; Ga. L. 2019, p. 148, § 1-8/HB 186.)

The 2019 amendment, effective July 1, 2019, designated the existing provisions of subsection (d) as paragraph (d)(1); added paragraph (d)(2); and, in subsection (h), substituted "permitted to oppose an application pursuant to paragraph (2) of subsection (d) of this Code section" for "opposed to an application" in the third sentence and substituted "any such" for "an" near the beginning of the fourth sentence.

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2008, subsection (g), as enacted by Ga. L. 2008, p. 12, § 1-1, was redesignated as subsection (k).

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

31-6-44. Certificate of Need Appeal Panel.

1. Effective July 1, 2008, there is created the Certificate of Need Appeal Panel, which shall be an agency separate and apart from the department and shall consist of a panel of independent hearing officers. The purpose of the appeal panel shall be to serve as a panel of independent hearing officers to review the department's initial decision to grant or deny a certificate of need application. The Health Planning Review Board which existed on June 30, 2008, shall cease to exist after that date and the Certificate of Need Appeal Panel shall be constituted effective July 1, 2008, pursuant to this Code section.
2. On and after July 1, 2008, the appeal panel shall be composed of five members appointed by the Governor for a term of up to four years each. The Governor shall appoint to the appeal panel attorneys who practice law in this state and who are familiar with the health care industry but who do not have a financial interest in or represent or have any compensation arrangement with any health care facility. Each member of the appeal panel shall be an active member of the State Bar of Georgia in good standing, and each attorney shall have maintained such active status for the five years immediately preceding such person's appointment. The Governor shall name from among such members a chairperson and a vice chairperson of the appeal panel. The vice chairperson shall have the same authority as the chairperson; provided, however, the vice chairperson shall not exercise such authority unless expressly delegated by the chairperson or in the event the chairperson becomes incapacitated, as determined by the Governor. Vacancies on the appeal panel caused by resignation, death, or any other cause shall be filled for the unexpired term in the same manner as the original appointment. No person required to register with the Secretary of State as a lobbyist or registered agent shall be eligible for appointment by the Governor to the appeal panel.
3. The appeal panel shall promulgate reasonable rules for its operation and rules of procedure for the conduct of initial administrative appeal hearings held by the appointed hearing officers, including an appropriate fee schedule for filing such appeals. Members of the appeal panel shall serve as hearing officers for appeals that are assigned to them on a random basis by the chairperson of the appeal panel. The members of the appeal panel shall receive no salary but shall be reimbursed for their expenses in attending meetings and for transportation costs as authorized by Code Section 45-7-21, which provides for compensation and allowances of certain state officials; provided, however, that the chairperson and vice chairperson of the appeal panel shall also be compensated for their services rendered to the appeal panel outside of attendance at an appeal panel meeting, such as for time spent assigning hearing officers, the amount of which compensation shall be determined according to regulations of the Department of Administrative Services. Appeal panel members shall receive compensation for the administration of the cases assigned to them, including prehearing, hearing, and posthearing work, in an amount determined to be appropriate and reasonable by the Department of Administrative Services. Such compensation to the members of the appeal panel shall be made by the Department of Administrative Services.
4. Any party that is permitted to oppose an application pursuant to paragraph (2) of subsection (d) of Code Section 31-6-43 that has notified the department prior to its decision that such party is opposed to the application before the department shall have the right to an initial administrative appeal hearing before an appeal panel hearing officer or to intervene in such hearing. Such request for hearing or intervention shall be filed with the chairperson of the appeal panel within 30 days of the date of the decision made pursuant to Code Section 31-6-43. In the event an appeal is filed by a party that is permitted to oppose an application pursuant to paragraph (2) of subsection (d) of Code Section 31-6-43, the appeal shall be accompanied by payment of such fee as is established by the appeal panel. In the event an appeal is requested, the chairperson of the appeal panel shall appoint a hearing officer for each such hearing within 30 days after the date the appeal is received. Within 14 days after the appointment of the hearing officer, such hearing officer shall confer with the parties and set the date or dates for the hearing, provided that no hearing shall be scheduled less than 60 days nor more than 120 days after the filing of the request for a hearing, unless the applicant consents or, in the case of competing applicants, all applicants consent to an extension of this time period to a specified date. Unless the applicant consents or, in the case of competing applicants, all applicants consent to an extension of said 120 day period, any hearing officer who regularly fails to commence a hearing within the required time period shall not be eligible for continued service as a hearing officer for the purposes of this Code section. The hearing officer shall have the authority to dispose of all motions made by any party before the issuance of the hearing officer's decision and shall make such rulings as may be required for the conduct of the hearing.
5. In fulfilling the functions and duties of this chapter, the hearing officer shall act, and the hearing shall be conducted as a full evidentiary hearing, in accordance with Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," relating to contested cases, except as otherwise specified in this Code section. Subject to the provisions of Article 4 of Chapter 18 of Title 50, all files, working papers, studies, notes, and other writings or information used by the department in making its decision shall be public records and available to the parties, and the hearing officer may permit each party to exercise such reasonable rights of prehearing discovery of such information used by the parties as will expedite the hearing.
6. In addition to evidence submitted to the department, a party may present any additional relevant evidence to the appeal panel hearing officer reviewing the decision of the department if the evidence was not reasonably available to the party presenting the evidence at the time of the department's review. The burden of proof as to whether the evidence was reasonably available shall be on the party attempting to introduce the new evidence. The issue for the decision by the hearing officer shall be whether, and the hearing officer shall order the issuance of a certificate of need if, in the hearing officer's judgment, the application is consistent with the considerations as set forth in Code Section 31-6-42 and the department's rules, as the hearing officer deems such considerations and rules applicable to the review of the project. The appeal hearing conducted by the appeal panel hearing officer shall be a de novo review of the decision of the department. The hearing officer shall also consider:
   1. Whether the department committed prejudicial procedural error in its consideration of the application;
   2. Whether the appeal lacks substantial justification; and
   3. Whether such appeal was undertaken primarily for the purpose of delay or harassment.

      The burden of proof shall be on the appellant. Appellants or applicants shall proceed first with their cases before the hearing officer in the order determined by the hearing officer, and the department, if a party, shall proceed last. In the event of a consolidated hearing on applications which were joined for comparative review pursuant to subsection (f) of Code Section 31-6-43, the hearing officer shall have the same powers specified for the department in subsection (f) of Code Section 31-6-43 to order the issuance of no certificate of need or one or more certificates of need.

7. All evidence shall be presented at the initial administrative appeal hearing conducted by the appointed hearing officer. A party or intervenor may present any relevant evidence on all issues raised by the hearing officer or any party to the hearing or revealed during discovery and shall not be limited to evidence or information presented to the department prior to its decision, except that an applicant may not present a new need study or analysis responsive to the general need consideration or service-specific need formula as provided in the applicable rules that is substantially different from any such study or analysis submitted to the department prior to its decision and that could have reasonably been available for submission. The hearing officer may consider the latest data available, including updates of studies previously submitted, in deciding whether an application is consistent with the applicable considerations or rules. The hearing officer shall consider the applicable considerations and rules in effect on the date the appeal is filed, even if the provisions of those considerations or rules were changed after the department's decision. The hearing officer may remand a matter to the department if the hearing officer determines that it would be beneficial for the department to consider new data, studies, or analyses that were not available before the decision or changes to the provisions of the applicable considerations or rules made after the department's decision. The hearing officer shall establish the time deadlines for completion of the remand and shall retain jurisdiction of the matter throughout the completion of the remand.
8. After the issuance of a decision by the department pursuant to Code Section 31-6-43, no party to an appeal hearing, nor any person on behalf of such party, including the department, shall make any ex parte contact with the appeal panel hearing officer appointed to conduct the appeal hearing, any other member of the appeal panel, or the commissioner in regard to a decision under appeal.
9. Within 30 days after the conclusion of the hearing, the hearing officer shall make written findings of fact and conclusions of law as to each consideration as set forth in Code Section 31-6-42 and the department's rules, including a detailed statement of the reasons for the decision of the hearing officer. If any party has alleged that an appeal lacks substantial justification or was undertaken primarily for the purpose of delay or harassment, the decision of the hearing officer shall make findings of fact addressing the merits of the allegation. The hearing officer shall file such decision with the chairperson of the appeal panel who shall serve such decision upon all parties, and shall transmit the administrative record to the commissioner. Any party, including the department, which disputes any finding of fact or conclusion of law rendered by the hearing officer in such hearing officer's decision and which wishes to appeal that decision may appeal to the commissioner and shall file its specific objections with the commissioner or his or her designee within 30 days of the date of the hearing officer's decision pursuant to rules adopted by the department.
10. The decision of the appeal panel hearing officer will become the final decision of the department upon the sixty-first day following the date of the decision unless an objection thereto is filed with the commissioner within the time limit established in subsection (i) of this Code section.
11. 1. In the event an appeal of the hearing officer's decision is filed, the commissioner may adopt the hearing officer's order as the final order of the department or the commissioner may reject or modify the conclusions of law over which the department has substantive jurisdiction and the interpretation of administrative rules over which it has substantive jurisdiction. By rejecting or modifying such conclusion of law or interpretation of administrative rule, the department must state with particularity its reasons for rejecting or modifying such conclusion of law or interpretation of administrative rule and must make a finding that its substituted conclusion of law or interpretation of administrative rule is as or more reasonable than that which was rejected or modified. Rejection or modification of conclusions of law may not form the basis for rejection or modification of findings of fact. The commissioner may not reject or modify the findings of fact unless the commissioner first determines from a review of the entire record, and states with particularity in the order, that the findings of fact were not based upon any competent substantial evidence or that the proceedings on which the findings were based did not comply with the essential requirements of law.
    2. If, before the date set for the commissioner's decision, application is made to the commissioner for leave to present additional evidence and it is shown to the satisfaction of the commissioner that the additional evidence is material and there were good reasons for failure to present it in the proceedings before the hearing officer, the commissioner may order that the additional evidence be taken before the same hearing officer who rendered the initial decision upon conditions determined by the commissioner. The hearing officer may modify the initial decision by reason of the additional evidence and shall file that evidence and any modifications, new findings, or decision with the commissioner. Unless leave is given by the commissioner in accordance with the provisions of this subsection, the appeal panel may not consider new evidence under any circumstances. In all circumstances, the commissioner's decision shall be based upon considerations as set forth in Code Section 31-6-42 and the department's rules.
12. If, based upon the findings of fact by the hearing officer, the commissioner determines that the appeal filed by any party of a decision of the department lacks substantial justification and was undertaken primarily for the purpose of delay or harassment, the commissioner may enter an award in his or her written order against such party and in favor of the successful party or parties, including the department, of all or any part of their respective reasonable and necessary attorney's fees and expenses of litigation, as the commissioner deems just. Such award may be enforced by any court undertaking judicial review of the final decision. In the absence of any petition for judicial review, then such award shall be enforced, upon due application, by any court having personal jurisdiction over the party against whom such an award is made.
13. Unless the hearing officer's decision becomes the department's final decision by operation of law as provided in subsection (j) of this Code section, the decision of the commissioner shall become the department's final decision by operation of law. Such final decision shall be the final department decision for purposes of Chapter 13 of Title 50, the "Georgia Administrative Procedure Act." The appeals process provided by this Code section shall be the administrative remedy only for decisions made by the department pursuant to Code Section 31-6-43 which involve the approval or denial of applications for certificates of need.
14. A party responding to an appeal to the commissioner may be entitled to reasonable attorney's fees and costs of such appeal if it is determined that the appeal lacked substantial justification and was undertaken primarily for the purpose of delay or harassment; provided, however, that the department shall not be required to pay attorney's fees or costs. This subsection shall not apply to the portion of attorney's fees accrued on behalf of a party responding to or bringing a challenge to the department's authority to enact a rule or regulation or the department's jurisdiction or another challenge that could not have been decided in the administrative proceeding, nor shall it apply to costs accrued when the only argument raised by the appealing party is one described in this subsection. (Code 1981, § 31-6-44 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1986, p. 744, § 1; Ga. L. 1990, p. 1469, § 1; Ga. L. 1990, p. 1903, § 8; Ga. L. 1994, p. 684, § 3; Ga. L. 1999, p. 296, § 22; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2019, p. 148, § 1-9/HB 186.)

The 2019 amendment, effective July 1, 2019, deleted the former last sentence of subsection (a), which read: "The terms of all members of the Health Planning Review Board serving as such on June 30, 2008, shall automatically terminate on such date."; and, in subsection (d), rewrote the first sentence, which read: "Any applicant for a project, any competing applicant in the same batching cycle, any competing health care facility that has notified the department prior to its decision that such facility is opposed to the application before the department, or any county or municipal government in whose boundaries the proposed project will be located who is aggrieved by a decision of the department shall have the right to an initial administrative appeal hearing before an appeal panel hearing officer or to intervene in such hearing.", and, in the third sentence, substituted "party that is permitted to oppose an application pursuant to paragraph (2) of subsection (d) of Code Section 31-6-43" for "competing applicant, or any competing health care facility, or any county or municipal government".

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2008, a second occurrence of the word "of" was deleted preceding "the date of" in the last sentence of subsection (i).

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

Administrative Rules and Regulations. - Administration, Official Compilation of the Rules and Regulations of the State of Georgia, Department of Community Health Certificate of Need Appeal Panel, Chapter 274-1.

Law reviews. - For annual survey of administrative law, see 38 Mercer L. Rev. 17 (1986). For annual survey of administrative law, see 56 Mercer L. Rev. 31 (2004).

31-6-44.1. Judicial review.

1. Any party to the initial administrative appeal hearing conducted by the appointed appeal panel hearing officer, excluding the department, may seek judicial review of the final decision in accordance with the method set forth in Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," except as otherwise modified by this Code section; provided, however, that in conducting such review, the court may reverse or modify the final decision only if substantial rights of the appellant have been prejudiced because the procedures followed by the department, the hearing officer, or the commissioner or the administrative findings, inferences, and conclusions contained in the final decision are:
   1. In violation of constitutional or statutory provisions;
   2. In excess of the statutory authority of the department;
   3. Made upon unlawful procedures;
   4. Affected by other error of law;
   5. Not supported by substantial evidence, which shall mean that the record does not contain such relevant evidence as a reasonable mind might accept as adequate to support such findings, inferences, conclusions, or decisions, which such evidentiary standard shall be in excess of the "any evidence" standard contained in other statutory provisions; or
   6. Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.
2. In the event a party seeks judicial review, the department shall, within 30 days of the filing of the notice of appeal with the superior court, transmit certified copies of all documents and papers in its file together with a transcript of the testimony taken and its findings of fact and decision to the clerk of the superior court to which the case has been appealed. The case so appealed may then be brought by either party upon ten days' written notice to the other before the superior court for a hearing upon such record, subject to an assignment of the case for hearing by the court; provided, however, if the court does not hear the case within 120 days of the date of docketing in the superior court, the decision of the department shall be considered affirmed by operation of law unless a hearing originally scheduled to be heard within the 120 days has been continued to a date certain by order of the court. In the event a hearing is held later than 90 days after the date of docketing in the superior court because same has been continued to a date certain by order of the court, the decision of the department shall be considered affirmed by operation of law if no order of the court disposing of the issues on appeal has been entered within 30 days after the date of the continued hearing. If a case is heard within 120 days from the date of docketing in the superior court, the decision of the department shall be considered affirmed by operation of law if no order of the court dispositive of the issues on appeal has been entered within 30 days of the date of the hearing.
3. A party responding to an appeal to the superior court shall be entitled to reasonable attorney's fees and costs if such party is the prevailing party of such appeal as decided by final order; provided, however, the department shall not be required to pay attorney's fees or costs. This subsection shall not apply to the portion of attorney's fees accrued on behalf of a party responding to or bringing a challenge to the department's authority to enact a rule or regulation or the department's jurisdiction or another challenge that could not have been raised in the administrative proceeding. (Code 1981, § 31-6-44.1 , enacted by Ga. L. 2008, p. 12, § 1-1/SB 433.)

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the enactment of this Code section shall only apply to applications submitted on or after July 1, 2008.

Law reviews. - For annual survey on administrative law, see 65 Mercer L. Rev. 41 (2013). For annual survey on administrative law, see 69 Mercer L. Rev. 15 (2017). For annual survey on administrative law, see 70 Mercer L. Rev. 1 (2018).

31-6-45. Revocation of certificate of need; enforcement of chapter; regulatory investigations and examinations.

1. The department may revoke a certificate of need, in whole or in part, after notice to the holder of the certificate and a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," for the following reasons:
   1. Failure to comply with the provisions of Code Section 31-6-41;
   2. The intentional provision of false information to the department by an applicant in that applicant's application;
   3. Repeated failure to pay any fines or moneys due to the department;
   4. Failure to maintain minimum quality of care standards that may be established by the department;
   5. Failure to participate as a provider of medical assistance for Medicaid purposes pursuant to Code Section 31-6-45.2 or any other applicable Code section;
   6. The failure to submit a timely or complete report within 180 days following the date the report is due pursuant to Code Section 31-6-70; or
   7. Failure of a destination cancer hospital to meet an annual patient base composed of a minimum of 65 percent of patients who reside outside this state for three calendar years in any five-year period.

      The department may not, however, revoke a certificate of need if the applicant changes the defined location of the project within the same county less than three miles from the location specified in the certificate of need for financial reasons or other reasons beyond its control, including, but not limited to, failure to obtain any required approval from zoning or other governmental agencies or entities, provided such change in location is otherwise consistent with the considerations and rules applied in the evaluation of the project.

   (a.1) The department may revoke a certificate of need, in whole or in part, after notice to the holder of the certificate and a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," if the services or units of services for which the certificate of need was issued are not implemented in a timely manner, as established by the department in its rules. This subsection shall apply only to certificates of need issued on or after July 1, 2008.

2. Any health care facility offering a new institutional health service without having obtained a certificate of need and which has not been previously licensed as a health care facility shall be denied a license to operate.
3. In the event that a new institutional health service is knowingly offered or developed without having obtained a certificate of need as required by this chapter, or the certificate of need for such service is revoked according to the provisions of this Code section, a facility or applicant may be fined an amount of $5,000.00 per day up to 30 days, $10,000.00 per day from 31 days through 60 days, and $25,000.00 per day after 60 days for each day that the violation of this chapter has existed and knowingly and willingly continues; provided, however, that the expenditure or commitment of or incurring an obligation for the expenditure of funds to take or perform actions not subject to this chapter or to acquire, develop, or prepare a health care facility site for which a certificate of need application is denied shall not be a violation of this chapter and shall not be subject to such a fine. The commissioner shall determine, after notice and a hearing, whether the fines provided in this Code section shall be levied.
4. In addition, for purposes of this Code section, the State of Georgia, acting by and through the department, or any other interested person, shall have standing in any court of competent jurisdiction to maintain an action for injunctive relief to enforce the provisions of this chapter.
5. The department shall have the authority to make public or private investigations or examinations inside or outside of this state to determine whether all provisions of this Code section or any other law, rule, regulation, or formal order relating to the provisions of Code Section 31-6-40 has been violated. Such investigations may be initiated at any time in the discretion of the department and may continue during the pendency of any action initiated by the department pursuant to subsection (a) of this Code section. For the purpose of conducting any investigation or inspection pursuant to this subsection, the department shall have the authority, upon providing reasonable notice, to require the production of any books, records, papers, or other information related to any certificate of need issue. (Code 1981, § 31-6-45 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1991, p. 1871, § 7; Ga. L. 1999, p. 296, § 22; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2009, p. 8, § 31/SB 46.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1985, a comma was deleted following "denied" near the end of the first sentence of subsection (c).

Pursuant to Code Section 28-9-5, in 1999, "commissioner" was substituted for "executive director" in the last sentence of subsection (c).

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

Law reviews. - For annual survey on administrative law, see 69 Mercer L. Rev. 15 (2017).

31-6-45.1. Automatic revocation of certificate of need or authority.

1. A health care facility which has a certificate of need or is otherwise authorized to operate pursuant to this chapter shall have such certificate of need or authority to operate automatically revoked by operation of law without any action by the department when that facility's permit to operate pursuant to Code Section 31-7-4 is finally revoked by order of the department. For purposes of this subsection, the date of such final revocation shall be as follows:
   1. When there is no appeal of the order pursuant to Chapter 5 of this title, the one hundred and eightieth day after the date upon which expires the time for appealing the revocation order without such an appeal being filed; or
   2. When there is an appeal of the order pursuant to Chapter 5 of this title, the date upon which expires the time to appeal the last administrative or judicial order affirming or approving the revocation or revocation order without such appeal being filed.
2. The services which had been authorized to be offered by a health care facility for which a certificate of need has been revoked pursuant to subsection (a) of this Code section may continue to be offered in the service area in which that facility was located under such conditions as specified by the department notwithstanding that some or all of such services could not otherwise be offered as new institutional health services. (Code 1981, § 31-6-45.1 , enacted by Ga. L. 1990, p. 860, § 1; Ga. L. 1991, p. 328, § 1; Ga. L. 1999, p. 296, § 22; Ga. L. 2000, p. 136, § 31; Ga. L. 2001, p. 4, § 31; Ga. L. 2008, p. 12, § 1-1/SB 433.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1996, "this title" was substituted for "Title 31" in paragraphs (a)(1) and (a)(2).

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

31-6-45.2. Participation as Medicaid provider requirement; termination by health care facility of participation as provider of medical assistance; monetary penalty.

1. The department may require that any applicant for a certificate of need agree to participate as a provider of medical assistance for Medicaid purposes pursuant to Article 7 of Chapter 4 of Title 49.
2. Any proposed or existing health care facility which obtains a certificate of need on or after April 6, 1992, based in part upon assurances that it will participate as a provider of medical assistance, as defined in paragraph (6) of Code Section 49-4-141, and which terminates its participation as a provider of medical assistance or violates any conditions imposed by the department relating to such participation, shall be subject to a monetary penalty in the amount of the difference between the Medicaid covered services which the facility agreed to provide in its certificate of need application and the amount actually provided and may be subject to revocation of its certificate of need by the department pursuant to Code Section 31-6-45; provided, however, that this Code section shall not apply if:
   1. The proposed or existing health care facility's certificate of need application was approved by the Health Planning Agency prior to April 6, 1992, and the Health Planning Agency's approval of such application was under appeal on or after April 6, 1992, and the Health Planning Agency's approval of such application is ultimately affirmed;
   2. Such facility's participation as a provider of medical assistance is terminated by the state or federal government; or
   3. Such facility establishes good cause for terminating its participation as a provider of medical assistance. For purposes of this Code section, "good cause" shall mean:
      1. Changes in the adequacy of medical assistance payments, as defined in paragraph (5) of Code Section 49-4-141, provided that at least 10 percent of the facility's utilization during the preceding 12 month period was attributable to services to recipients of medical assistance, as defined in paragraph (7) of Code Section 49-4-141. Medical assistance payments to a facility shall be presumed adequate unless the revenues received by the facility from all sources are less than the total costs set forth in the cost report for the preceding full 12 month period filed by such facility pursuant to the state plan as defined in paragraph (8) of Code Section 49-4-141 which are allowed under the state plan for purposes of determining such facility's reimbursement rate for medical assistance and the aggregate amount of such facility's medical assistance payments (including any amounts received by the facility from recipients of medical assistance) during the preceding full 12 month cost reporting period is less than 85 percent of such facility's Medicaid costs for such period. Medicaid costs shall be determined by multiplying the allowable costs set forth in the cost report, less any audit adjustments, by the percentage of the facility's utilization during the cost reporting period which was attributable to recipients of medical assistance;
      2. Changes in the overall ability of the facility to cover its costs if such changes are of such a degree as to seriously threaten the continued viability of the facility; or
      3. Changes in the state plan, statutes, or rules and regulations governing providers of medical assistance which impose substantial new obligations upon the facility which are not reimbursed by Medicaid and which adversely affect the financial viability of the facility in a substantial manner.
3. A facility seeking to terminate its enrollment as a provider of medical assistance shall submit a written request to the department documenting good cause for termination. The department shall grant or deny the facility's request within 30 days. If the department denies the facility's request, the facility shall be entitled to a hearing conducted in the same manner as an evidentiary hearing conducted by the department pursuant to the provisions of Code Section 49-4-153 within 30 days of the department's decision.
4. The imposition of the monetary penalty provided in this Code section shall commence upon the date that said facility has terminated its participation as a provider of medical assistance, as determined by the commissioner. The monetary penalty shall be levied and collected by the department on an annual basis for every year in which the facility fails to participate as a provider of medical assistance. Penalties authorized under this Code section shall be subject to the same notices and hearings as provided for levy of fines under Code Section 31-6-45 . (Code 1981, § 31-6-45 .2, enacted by Ga. L. 1992, p. 1068, § 2; Ga. L. 1999, p. 296, §§ 22, 24; Ga. L. 2008, p. 12, § 1-1/SB 433.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1992, "April 6, 1992" was substituted for "the effective date of this Code section" in the introductory language of subsection (a) (now subsection (b)) and in paragraph (a)(1) (now paragraph (b)(1)), and "government" was substituted for "governments" in paragraph (a)(2) (now paragraph (b)(2)).

Pursuant to Code Section 28-9-5, in 1999, "Health Planning Agency" was substituted for "department" and "Health Planning Agency's" was substituted for "department's" in paragraph (a)(1) (now paragraph (b)(1)) and "commissioner" was substituted for "executive director" in the first sentence of subsection (c) (now subsection (d)).

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

Law reviews. - For note on 1992 enactment of this Code section, see 9 Ga. St. U. L. Rev. 265 (1992).

31-6-46. Annual report by department.

The department shall prepare and submit an annual report to the board and to the Health and Human Services Committee of the Senate and the Health and Human Services Committee of the House of Representatives about its operations and decisions for the preceding 12 month period, not later than 30 days prior to each convening of the General Assembly in regular session. Either committee may request any additional reports or information, including decisions, from the department at any time, including a period in which the General Assembly is not in regular session. The annual report shall include information and updates relating to the state health plan and the certificate of need program and an annual analysis of proactive and prospective approaches to need methodologies and access to health care services. The annual report shall include information for Georgia's congressional delegation which highlights issues regarding federal laws and regulations influencing Medicaid and medicare, insurance and related tax laws, and long-term health care.

(Code 1981, § 31-6-46 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1992, p. 6, § 31; Ga. L. 1999, p. 296, § 22; Ga. L. 2005, p. 48, § 2/HB 309; Ga. L. 2008, p. 12, § 1-1/SB 433.)

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

31-6-47. Exemptions from chapter.

1. Notwithstanding the other provisions of this chapter, this chapter shall not apply to:
   1. Infirmaries operated by educational institutions for the sole and exclusive benefit of students, faculty members, officers, or employees thereof;
   2. Infirmaries or facilities operated by businesses for the sole and exclusive benefit of officers or employees thereof, provided that such infirmaries or facilities make no provision for overnight stay by persons receiving their services;
   3. Institutions operated exclusively by the federal government or by any of its agencies;
   4. Offices of private physicians or dentists whether for individual or group practice, except as otherwise provided in paragraph (3) or (7) of subsection (a) of Code Section 31-6-40;
   5. Religious, nonmedical health care institutions as defined in 42 U.S.C. Section 1395x(ss)(1), listed and certified by a national accrediting organization;
   6. Site acquisitions for health care facilities or preparation or development costs for such sites prior to the decision to file a certificate of need application;
   7. Expenditures related to adequate preparation and development of an application for a certificate of need;
   8. The commitment of funds conditioned upon the obtaining of a certificate of need;
   9. Expenditures for the restructuring or acquisition of existing health care facilities by stock or asset purchase, merger, consolidation, or other lawful means;

      (9.1) The purchase of a closing hospital or of a hospital that has been closed for no more than 12 months by a hospital in a contiguous county to repurpose the facility as a micro-hospital;

   10. Expenditures of less than $870,000.00 for any minor or major repair or replacement of equipment by a health care facility that is not owned by a group practice of physicians or a hospital and that provides diagnostic imaging services if such facility received a letter of nonreviewability from the department prior to July 1, 2008. This paragraph shall not apply to such facilities in rural counties;

       (10.1) Except as provided in paragraph (10) of this subsection, expenditures for the minor or major repair of a health care facility or a facility that is exempt from the requirements of this chapter, parts thereof or services provided or equipment used therein; or the replacement of equipment, including but not limited to CT scanners, magnetic resonance imaging, positron emission tomography (PET), and positron emission tomography/computed tomography previously approved for a certificate of need;

   11. Capital expenditures otherwise covered by this chapter required solely to eliminate or prevent safety hazards as defined by federal, state, or local fire, building, environmental, occupational health, or life safety codes or regulations, to comply with licensing requirements of the department, or to comply with accreditation standards of a nationally recognized health care accreditation body;
   12. Cost overruns whose percentage of the cost of a project is equal to or less than the cumulative annual rate of increase in the composite construction index, published by the United States Bureau of the Census of the Department of Commerce, calculated from the date of approval of the project;
   13. Transfers from one health care facility to another such facility of major medical equipment previously approved under or exempted from certificate of need review, except where such transfer results in the institution of a new clinical health service for which a certificate of need is required in the facility acquiring such equipment, provided that such transfers are recorded at net book value of the medical equipment as recorded on the books of the transferring facility;
   14. New institutional health services provided by or on behalf of health maintenance organizations or related health care facilities in circumstances defined by the department pursuant to federal law;
   15. Increases in the bed capacity of a hospital up to ten beds or 10 percent of capacity, whichever is greater, in any consecutive two-year period, in a hospital that has maintained an overall occupancy rate greater than 75 percent for the previous 12 month period;
   16. Expenditures for nonclinical projects, including parking lots, parking decks, and other parking facilities; computer systems, software, and other information technology; medical office buildings; administrative office space; conference rooms; education facilities; lobbies; common spaces; clinical staff lounges and sleep areas; waiting rooms; bathrooms; cafeterias; hallways; engineering facilities; mechanical systems; roofs; grounds; signage; family meeting or lounge areas; other nonclinical physical plant renovations or upgrades that do not result in new or expanded clinical health services, and state mental health facilities;
   17. Life plan communities, provided that the skilled nursing component of the facility is for the exclusive use of residents of the life plan community and that a written exemption is obtained from the department; provided, however, that new sheltered nursing home beds may be used on a limited basis by persons who are not residents of the life plan community for a period up to five years after the date of issuance of the initial nursing home license, but such beds shall not be eligible for Medicaid reimbursement. For the first year, the life plan community sheltered nursing facility may utilize not more than 50 percent of its licensed beds for patients who are not residents of the life plan community. In the second year of operation, the life plan community shall allow not more than 40 percent of its licensed beds for new patients who are not residents of the life plan community. In the third year of operation, the life plan community shall allow not more than 30 percent of its licensed beds for new patients who are not residents of the life plan community. In the fourth year of operation, the life plan community shall allow not more than 20 percent of its licensed beds for new patients who are not residents of the life plan community. In the fifth year of operation, the life plan community shall allow not more than 10 percent of its licensed beds for new patients who are not residents of the life plan community. At no time during the first five years shall the life plan community sheltered nursing facility occupy more than 50 percent of its licensed beds with patients who are not residents under contract with the life plan community. At the end of the five-year period, the life plan community sheltered nursing facility shall be utilized exclusively by residents of the life plan community, and at no time shall a resident of a life plan community be denied access to the sheltered nursing facility. At no time shall any existing patient be forced to leave the life plan community to comply with this paragraph. The department is authorized to promulgate rules and regulations regarding the use and definition of "sheltered nursing facility" in a manner consistent with this Code section. Agreements to provide continuing care include agreements to provide care for any duration, including agreements that are terminable by either party;
   18. Any single specialty ambulatory surgical center that:
       1. 1. Has capital expenditures associated with the construction, development, or other establishment of the clinical health service which do not exceed $2.5 million; or
          2. Is the only single specialty ambulatory surgical center in the county owned by the group practice and has two or fewer operating rooms; provided, however, that a center exempt pursuant to this division shall be required to obtain a certificate of need in order to add any additional operating rooms;
       2. Has a hospital affiliation agreement with a hospital within a reasonable distance from the facility or the medical staff at the center has admitting privileges or other acceptable documented arrangements with such hospital to ensure the necessary backup for the center for medical complications. The center shall have the capability to transfer a patient immediately to a hospital within a reasonable distance from the facility with adequate emergency room services. Hospitals shall not unreasonably deny a transfer agreement or affiliation agreement to the center;
       3. 1. Provides care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids beneficiaries and provides uncompensated indigent and charity care in an amount equal to or greater than 2 percent of its adjusted gross revenue; or
          2. If the center is not a participant in Medicaid or the PeachCare for Kids Program, provides uncompensated care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids beneficiaries, uncompensated indigent and charity care, or both in an amount equal to or greater than 4 percent of its adjusted gross revenue;

             provided, however, that single specialty ambulatory surgical centers owned by physicians in the practice of ophthalmology shall not be required to comply with this subparagraph; and

       4. Provides annual reports in the same manner and in accordance with Code Section 31-6-70.

          Noncompliance with any condition of this paragraph shall result in a monetary penalty in the amount of the difference between the services which the center is required to provide and the amount actually provided and may be subject to revocation of its exemption status by the department for repeated failure to pay any fines or moneys due to the department or for repeated failure to produce data as required by Code Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act." The dollar amount specified in this paragraph shall be adjusted annually by an amount calculated by multiplying such dollar amount (as adjusted for the preceding year) by the annual percentage of change in the composite index of construction material prices, or its successor or appropriate replacement index, if any, published by the United States Department of Commerce for the preceding calendar year, commencing on July 1, 2009, and on each anniversary thereafter of publication of the index. The department shall immediately institute rule-making procedures to adopt such adjusted dollar amounts. In calculating the dollar amounts of a proposed project for purposes of this paragraph, the costs of all items subject to review by this chapter and items not subject to review by this chapter associated with and simultaneously developed or proposed with the project shall be counted, except for the expenditure or commitment of or incurring an obligation for the expenditure of funds to develop certificate of need applications, studies, reports, schematics, preliminary plans and specifications or working drawings, or to acquire sites;

   19. Any joint venture ambulatory surgical center that:
       1. Has capital expenditures associated with the construction, development, or other establishment of the clinical health service which do not exceed $5 million;
       2. 1. Provides care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids beneficiaries and provides uncompensated indigent and charity care in an amount equal to or greater than 2 percent of its adjusted gross revenue; or
          2. If the center is not a participant in Medicaid or the PeachCare for Kids Program, provides uncompensated care to Medicaid beneficiaries and, if the facility provides medical care and treatment to children, to PeachCare for Kids beneficiaries, uncompensated indigent and charity care, or both in an amount equal to or greater than 4 percent of its adjusted gross revenue; and
       3. Provides annual reports in the same manner and in accordance with Code Section 31-6-70.

          Noncompliance with any condition of this paragraph shall result in a monetary penalty in the amount of the difference between the services which the center is required to provide and the amount actually provided and may be subject to revocation of its exemption status by the department for repeated failure to pay any fines or moneys due to the department or for repeated failure to produce data as required by Code Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act." The dollar amount specified in this paragraph shall be adjusted annually by an amount calculated by multiplying such dollar amount (as adjusted for the preceding year) by the annual percentage of change in the composite index of construction material prices, or its successor or appropriate replacement index, if any, published by the United States Department of Commerce for the preceding calendar year, commencing on July 1, 2009, and on each anniversary thereafter of publication of the index. The department shall immediately institute rule-making procedures to adopt such adjusted dollar amounts. In calculating the dollar amounts of a proposed project for purposes of this paragraph, the costs of all items subject to review by this chapter and items not subject to review by this chapter associated with and simultaneously developed or proposed with the project shall be counted, except for the expenditure or commitment of or incurring an obligation for the expenditure of funds to develop certificate of need applications, studies, reports, schematics, preliminary plans and specifications or working drawings, or to acquire sites;

   20. Expansion of services by an imaging center based on a population needs methodology taking into consideration whether the population residing in the area served by the imaging center has a need for expanded services, as determined by the department in accordance with its rules and regulations, if such imaging center:
       1. Was in existence and operational in this state on January 1, 2008;
       2. Is owned by a hospital or by a physician or a group of physicians comprising at least 80 percent ownership who are currently board certified in radiology;
       3. Provides three or more diagnostic and other imaging services;
       4. Accepts all patients regardless of ability to pay; and
       5. Provides uncompensated indigent and charity care in an amount equal to or greater than the amount of such care provided by the geographically closest general acute care hospital; provided, however, that this paragraph shall not apply to an imaging center in a rural county;
   21. Diagnostic cardiac catheterization in a hospital setting on patients 15 years of age and older;
   22. Therapeutic cardiac catheterization in hospitals selected by the department prior to July 1, 2008, to participate in the Atlantic Cardiovascular Patient Outcomes Research Team (C-PORT) Study and therapeutic cardiac catheterization in hospitals that, as determined by the department on an annual basis, meet the criteria to participate in the C-PORT Study but have not been selected for participation; provided, however, that if the criteria requires a transfer agreement to another hospital, no hospital shall unreasonably deny a transfer agreement to another hospital;
   23. Infirmaries or facilities operated by, on behalf of, or under contract with the Department of Corrections or the Department of Juvenile Justice for the sole and exclusive purpose of providing health care services in a secure environment to prisoners within a penal institution, penitentiary, prison, detention center, or other secure correctional institution, including correctional institutions operated by private entities in this state which house inmates under the Department of Corrections or the Department of Juvenile Justice;
   24. The relocation of any skilled nursing facility, intermediate care facility, or micro-hospital within the same county, any other health care facility in a rural county within the same county, and any other health care facility in an urban county within a three-mile radius of the existing facility so long as the facility does not propose to offer any new or expanded clinical health services at the new location;
   25. Facilities which are devoted to the provision of treatment and rehabilitative care for periods continuing for 24 hours or longer for persons who have traumatic brain injury, as defined in Code Section 37-3-1;
   26. Capital expenditures for a project otherwise requiring a certificate of need if those expenditures are for a project to remodel, renovate, replace, or any combination thereof, a medical-surgical hospital and:
       1. That hospital:
          1. Has a bed capacity of not more than 50 beds;
          2. Is located in a county in which no other medical-surgical hospital is located;
          3. Has at any time been designated as a disproportionate share hospital by the department; and
          4. Has at least 45 percent of its patient revenues derived from medicare, Medicaid, or any combination thereof, for the immediately preceding three years; and
       2. That project:
          1. Does not result in any of the following:
             1. The offering of any new clinical health services;
             2. Any increase in bed capacity;
             3. Any redistribution of existing beds among existing clinical health services; or
             4. Any increase in capacity of existing clinical health services;
          2. Has at least 80 percent of its capital expenditures financed by the proceeds of a special purpose county sales and use tax imposed pursuant to Article 3 of Chapter 8 of Title 48; and
          3. Is located within a three-mile radius of and within the same county as the hospital's existing facility;
   27. The renovation, remodeling, refurbishment, or upgrading of a health care facility, so long as the project does not result in any of the following:
       1. The offering of any new or expanded clinical health services;
       2. Any increase in inpatient bed capacity;
       3. Any redistribution of existing beds among existing clinical health services; or
       4. A capital expenditure exceeding the threshold contained in paragraph (2) of subsection (a) of Code Section 31-6-40;
   28. Other than for equipment used to provide positron emission tomography (PET) services, the acquisition of diagnostic, therapeutic, or other imaging equipment with a value of $3 million or less, by or on behalf of:
       1. A hospital; or
       2. An individual private physician or single group practice of physicians exclusively for use on patients of such private physician or single group practice of physicians and such private physician or member of such single group practice of physicians is physically present at the practice location where the diagnostic or other imaging equipment is located at least 75 percent of the time that the equipment is in use.

          The amount specified in this paragraph shall not include build-out costs, as defined by the department, but shall include all functionally related equipment, software, and any warranty and services contract costs for the first five years. The acquisition of one or more items of functionally related diagnostic or therapeutic equipment shall be considered as one project. The dollar amount specified in this paragraph and in paragraph (10) of this subsection shall be adjusted annually by an amount calculated by multiplying such dollar amounts (as adjusted for the preceding year) by the annual percentage of change in the consumer price index, or its successor or appropriate replacement index, if any, published by the United States Department of Labor for the preceding calendar year, commencing on July 1, 2010; and

   29. A capital expenditure of $10 million or less by a hospital at such hospital's primary campus for:
       1. The expansion or addition of the following clinical health services: operating rooms, other than dedicated outpatient operating rooms; medical-surgical services; gynecology; procedure rooms; intensive care; pharmaceutical services; pediatrics; cardiac care or other general hospital services; provided, however, that such expenditure does not include the expansion or addition of inpatient beds or the conversion of one type of inpatient bed to another type of inpatient bed; or
       2. The movement of clinical health services from one location on the hospital's primary campus to another location on such hospital's primary campus.
2. By rule, the department shall establish a procedure for expediting or waiving reviews of certain projects the nonreview of which it deems compatible with the purposes of this chapter, in addition to expenditures exempted from review by this Code section. (Code 1981, § 31-6-47 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1984, p. 22, § 31; Ga. L. 1989, p. 393, § 1; Ga. L. 1991, p. 1419, § 2; Ga. L. 1991, p. 1871, § 8; Ga. L. 1999, p. 296, §§ 22, 24; Ga. L. 2008, p. 9, § 2/HB 967; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2009, p. 8, § 31/SB 46; Ga. L. 2009, p. 453, § 1-24/HB 228; Ga. L. 2012, p. 337, § 1/SB 361; Ga. L. 2018, p. 132, § 5/HB 769; Ga. L. 2019, p. 148, § 1-10/HB 186; Ga. L. 2019, p. 945, § 3/HB 300; Ga. L. 2019, p. 1056, § 31/SB 52.)

The 2018 amendment, effective July 1, 2018, added paragraph (a)(9.2); and inserted ", or micro-hospital" near the middle of paragraph (a)(24).

The 2019 amendments. The first 2019 amendment, effective July 1, 2019, substituted "42 U.S.C. Section" for "42 U.S.C. § " in paragraph (a)(5); substituted the present provisions of paragraph (a)(9) for the former provisions, which read: "Expenditures for the acquisition of existing health care facilities by stock or asset purchase, merger, consolidation, or other lawful means unless the facilities are owned or operated by or on behalf of a:

"(A) Political subdivision of this state;

"(B) Combination of such political subdivisions; or

"(C) Hospital authority, as defined in Article 4 of Chapter 7 of this title;"; deleted former paragraph (a)(9.1), which read: "Expenditures for the restructuring of or for the acquisition by stock or asset purchase, merger, consolidation, or other lawful means of an existing health care facility which is owned or operated by or on behalf of any entity described in subparagraph (A), (B), or (C) of paragraph (9) of this subsection only if such restructuring or acquisition is made by any entity described in subparagraph (A), (B), or (C) of paragraph (9) of this subsection;"; redesignated former paragraph (a)(9.2) as present paragraph (a)(9.1); inserted ", magnetic resonance imaging, positron emission tomography (PET), and positron emission tomography/computed tomography" near the end of paragraph (a)(10.1); in paragraph (a)(12), inserted "United States" and deleted "of the United States government," preceding "calculated from the date"; substituted "such equipment" for "said equipment" in the middle of paragraph (a)(13); inserted "administrative office space; conference rooms; education facilities; lobbies; common spaces; clinical staff lounges and sleep areas; waiting rooms; bathrooms; cafeterias; hallways; engineering facilities; mechanical systems; roofs; grounds; signage; family meeting or lounge areas; other nonclinical physical plant renovations or upgrades that do not result in new or expanded clinical health services," in paragraph (a)(16); inserted "that" near the beginning of the proviso following division (a)(18)(C)(ii) and in the proviso in subparagraph (a)(20)(E); deleted "and" at the end of paragraph (a)(25); substituted a semicolon for a period at the end of division (a)(26)(B)(iii); and added paragraphs (a)(27) through (a)(29). The second 2019 amendment, effective July 1, 2019, in paragraph (17), substituted "life plan" for "continuing care retirement" throughout the paragraph. The third 2019 amendment, effective May 12, 2019, part of an Act to revise, modernize, and correct the Code, inserted "that" following "provided, however," in the undesignated language at the end of subparagraph (a)(18)(C) and in subparagraph (a)(20)(E).

Code Commission notes. - The amendment of this Code section by Ga. L. 2008, p. 9, § 2/HB 967, irreconcilably conflicted with and was treated as superseded by Ga. L. 2008, p. 12, § 1-1/SB 433. See County of Butts v. Strahan, 151 Ga. 417 (1921).

Pursuant to Code Section 28-9-5, in 2019, "continuing care retirement" was deleted near the end of paragraph (a)(17).

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section by that Act shall only apply to applications submitted on or after July 1, 2008.

31-6-47.1. Prior notice and approval of certain activities.

The department shall require prior notice from a new health care facility for approval of any activity which is believed to be exempt pursuant to Code Section 31-6-47 or excluded from the requirements of this chapter under other provisions of this chapter. The department may require prior notice and approval of any activity which is believed to be exempt pursuant to paragraphs (10), (15), (16), (17), (20), (21), (23), (25), (26), (27), (28), and (29) of subsection (a) of Code Section 31-6-47. The department shall establish timeframes, forms, and criteria to request a letter of determination that an activity is properly exempt or excluded under this chapter prior to its implementation. The department shall publish notice of all requests for letters of determination regarding exempt activity and opposition to such request. Persons opposing a request for approval of an exempt activity shall be entitled to file an objection with the department and the department shall consider any filed objection when determining whether an activity is exempt. After the department's decision, an opposing party shall have the right to a fair hearing pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," on an adverse decision of the department and judicial review of a final decision in the same manner and under the same provisions as in Code Section 31-6-44.1. If no objection to a request for determination is filed within 30 days of the department's receipt of such request for determination, the department shall have 60 days from the date of the department's receipt of such request to review the request and issue a letter of determination. The department may adopt rules for deciding when it is not practicable to provide a determination in 60 days and may extend the review period upon written notice to the requestor but only for an extended period of no longer than an additional 30 days.

(Code 1981, § 31-6-47.1 , enacted by Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2019, p. 148, § 1-11/HB 186.)

The 2019 amendment, effective July 1, 2019, substituted "(25), (26), (27), (28), and (29)" for "(25), and (26)" in the second sentence, substituted "department shall establish timeframes, forms, and criteria to request a letter of determination" for "department shall be authorized to establish timeframes, forms, and criteria relating to its certification" in the third sentence, substituted "letters of determination regarding" for "approval of an" in the fourth sentence, and added the last two sentences.

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the enactment of this Code section shall only apply to applications submitted on or after July 1, 2008.

31-6-48. Prior entities abolished; transfer of contractual obligations.

The State Health Planning and Development Agency, the State-wide Health Coordinating Council, and the State Health Planning Review Board existing immediately prior to July 1, 1983, are abolished, and their respective successors on and after July 1, 1983, shall be the Health Planning Agency, the Health Policy Council, and the Health Planning Review Board, as established in this chapter, except that on and after July 1, 1991, the Health Strategies Council shall be the successor to the Health Policy Council, and except that on and after July 1, 1999, the Department of Community Health shall be the successor to the Health Planning Agency, and except that on and after July 1, 2008, the Board of Community Health shall be the successor to the duties of the Health Strategies Council with respect to adoption of the state health plan, and except that on June 30, 2008, the Health Planning Review Board is abolished and the terms of all members on such board on such date shall automatically terminate and the Certificate of Need Appeal Panel shall be the successor to the duties of the Health Planning Review Board on such date. For purposes of any existing contract with the federal government, or federal law referring to such abolished agency, council, or board, the successor department, council, or board established in this chapter or in Chapter 2 of this title shall be deemed to be the abolished agency, council, or board and shall succeed to the abolished agency's, council's, or board's functions. The State Health Planning and Development Commission is abolished.

(Code 1981, § 31-6-48 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1985, p. 149, § 31; Ga. L. 1991, p. 1880, § 4; Ga. L. 1999, p. 296, § 8; Ga. L. 2000, p. 136, § 31; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2009, p. 453, § 1-25/HB 228.)

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

31-6-49. Transitional provisions.

All matters transferred to the Health Planning Agency by the previously existing provisions of this Code section and that are in effect on June 30, 1999, shall automatically be transferred to the Department of Community Health on July 1, 1999. All matters of the Health Planning Review Board that are pending on June 30, 2008, shall automatically be transferred to the Certificate of Need Appeal Panel established pursuant to Code Section 31-6-44.

(Code 1981, § 31-6-49 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1985, p. 149, § 31; Ga. L. 1999, p. 296, § 8; Ga. L. 2008, p. 12, § 1-1/SB 433.)

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

31-6-50. Application of review procedures to expenditures under Section 1122 of the federal Social Security Act.

The review and appeal considerations and procedures set forth in Code Sections 31-6-42 through 31-6-44, respectively, shall apply to and govern the review of capital expenditures under the Section 1122 program of the federal Social Security Act of 1935, as amended, including, but not limited to, any application for approval under Section 1122 which is under consideration by the Health Planning Agency or on appeal before the Certificate of Need Appeal Panel, successor to the former Health Planning Review Board as of June 30, 2008.

(Code 1981, § 31-6-50 , enacted by Ga. L. 1983, p. 1566, § 1; Ga. L. 1985, p. 149, § 31; Ga. L. 1999, p. 296, § 22; Ga. L. 2008, p. 12, § 1-1/SB 433.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1985, "31-6-42 through 31-6-44" was substituted for "31-6-42, 31-6-43, and 31-6-44".

Pursuant to Code Section 28-9-5, in 1999, "Health Planning Agency" was substituted for "department".

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

U.S. Code. - Section 1122 of the Social Security Act, as amended, referred to in this Code section, is codified as 42 U.S.C. § 1320a-1.

31-6-70. Reports to the department by certain health care facilities and all ambulatory surgical centers and imaging centers; public availability.

1. There shall be required from each health care facility in this state requiring a certificate of need and all ambulatory surgical centers and imaging centers, whether or not exempt from obtaining a certificate of need under this chapter, an annual report of such health care information as determined by the department. The report shall be due on the date determined by the department and shall cover the 12 month period preceding each such calendar year.
2. The report required under subsection (a) of this Code section shall contain the following information:
   1. Total gross revenues;
   2. Bad debts;
   3. Amounts of free care extended, excluding bad debts;
   4. Contractual adjustments;
   5. Amounts of care provided under a Hill-Burton commitment;
   6. Amounts of charity care provided to indigent and nonindigent persons;
   7. Amounts of outside sources of funding from governmental entities, philanthropic groups, or any other source, including the proportion of any such funding dedicated to the care of indigent persons;
   8. For cases involving indigent persons and nonindigent person receiving charity care:
      1. The number of persons treated;
      2. The number of inpatients and outpatients;
      3. Total patient days;
      4. The number of patients categorized by county of residence; and
      5. The indigent and nonindigent care costs incurred by the health care facility by county of residence;
   9. Transfers to a hospital or hospital emergency department, including both direct transfers and transfers by emergency medical services;
   10. Number of rooms, beds, procedures, and patients, including, without limitation, demographic information and payer source;
   11. Patient origin by county; and
   12. Operational information such as procedure types, volumes, and charges.
3. As used in subsection (b) of this Code section, "indigent persons" means persons having as a maximum allowable income level an amount corresponding to 125 percent of the federal poverty guideline.
4. The department shall provide a form for the reports required by this Code section and may provide in said form for further categorical divisions of the information listed in subsection (b) or (c.1) of this Code section.
5. 1. In the event the department does not receive an annual report from a health care facility requiring a certificate of need or an ambulatory surgical center or imaging center, whether or not exempt from obtaining a certificate of need under this chapter, on or before the date such report was due or receives a timely but incomplete report, the department shall notify the health care facility or center regarding the deficiencies and shall be authorized to fine such health care facility or center an amount not to exceed $500.00 per day for every day up to 30 days and $1,000.00 per day for every day over 30 days for every day of such untimely or deficient report.
   2. In the event the department does not receive an annual report from a health care facility within 180 days following the date such report was due or receives a timely but incomplete report which is not completed within such 180 days, the department shall be authorized to revoke such health care facility's certificate of need in accordance with Code Section 31-6-45.
6. No application for a certificate of need under Article 3 of this chapter shall be considered as complete if the applicant has not submitted the annual report required by subsection (a) of this Code section.
7. The department shall make publicly available all annual reports submitted pursuant to this Code section on the department website. The department shall also provide a copy of such annual reports to the Governor, the President of the Senate, the Speaker of the House of Representatives, and the chairpersons of the House Committee on Health and Human Services and the Senate Health and Human Services Committee.
8. All health care facilities, ambulatory surgical centers, and imaging centers required to submit an annual report pursuant to subsection (a) of this Code section shall make such annual reports publicly available on their websites. (Code 1981, § 31-6-70 , enacted by Ga. L. 1985, p. 827, § 1; Ga. L. 1987, p. 573, § 1; Ga. L. 1988, p. 13, § 31; Ga. L. 1999, p. 296, § 22; Ga. L. 2008, p. 12, § 1-1/SB 433; Ga. L. 2019, p. 148, § 1-12/HB 186; Ga. L. 2020, p. 493, § 31/SB 429.)

The 2019 amendment, effective July 1, 2019, in subsection (a), substituted "report of such health care information as determined by" for "report of certain health care information to be submitted to" near the end of the first sentence and substituted "date determined by the department" for "last day of January" in the second sentence; inserted "and nonindigent" in paragraph (b)(6) and subparagraph (b)(8)(E); deleted "and" at the end of paragraph (b)(7); inserted "and nonindigent person receiving charity care" in paragraph (b)(8); substituted a semicolon for a period at the end of subparagraph (b)(8)(E); and added paragraphs (b)(9) through (b)(12); in subsection (d), substituted "reports required by this Code section" for "report required by subsection (a) of this Code section" near the middle and substituted "subsections (b) or (c.1)" for "subsection (b)" near the end; deleted "information responsive to subparagraph (c)(2)(A) of Code Section 31-6-40 by December 30, 2008, or" following "does not receive" near the beginning of paragraph (e)(1); and added subsections (g) and (h).

The 2020 amendment, effective July 29, 2020, part of an Act to revise, modernize, and correct the Code, substituted "subsection (b)" for "subsections (b)" in subsection (d).

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2008, "within such" was substituted for "with such" in paragraph (e)(2).

Editor's notes. - Ga. L. 2008, p. 12, § 3-1/SB 433, not codified by the General Assembly, provides that the amendment to this Code section shall only apply to applications submitted on or after July 1, 2008.

Law reviews. - For annual survey on administrative law, see 64 Mercer L. Rev. 39 (2012).

31-6-90 through 31-6-95.

Repealed pursuant to Code Section 31-6-95, which provided for the repeal of this article on June 30, 2007.

Editor's notes. - This article was based on Code 1981, §§ 31-6-90 through 31-6-95, enacted by Ga. L. 2005, p. 43, § 1/HB 390.

31-7-1. (See Editor's notes.) Definitions.

As used in this chapter, the term:

1. "Board" means the Board of Community Health.
2. "Commissioner" means the commissioner of community health.
3. "Department" means the Department of Community Health.
4. "Institution" means:
   1. Any building, facility, or place in which are provided two or more beds and other facilities and services that are used for persons received for examination, diagnosis, treatment, surgery, maternity care, nursing care, assisted living care, or personal care for periods continuing for 24 hours or longer and which is classified by the department, as provided for in this chapter, as either a hospital, nursing home, assisted living community, or personal care home;
   2. Any health facility wherein abortion procedures under subsections (b) and (c) of Code Section 16-12-141 are performed or are to be performed;
   3. Any building or facility, not under the operation or control of a hospital, which is primarily devoted to the provision of surgical treatment to patients not requiring hospitalization and which is classified by the department as an ambulatory surgical treatment center;
   4. Any fixed or mobile specimen collection center or health testing facility where specimens are taken from the human body for delivery to and examination in a licensed clinical laboratory or where certain measurements such as height and weight determination, limited audio and visual tests, and electrocardiograms are made, excluding public health services operated by the state, its counties, or municipalities;
   5. Any building or facility where human births occur on a regular and ongoing basis and which is classified by the department as a birthing center;
   6. Any building or facility which is devoted to the provision of treatment and rehabilitative care for periods continuing for 24 hours or longer for persons who have traumatic brain injury, as defined in Code Section 37-3-1; or
   7. Any freestanding imaging center where magnetic resonance imaging, computed tomography (CT) scanning, positron emission tomography (PET) scanning, positron emission tomography/computed tomography, and other advanced imaging services as defined by the department by rule, but not including X-rays, fluoroscopy, or ultrasound services, are conducted in a location or setting not affiliated or attached to a hospital or in the offices of an individual private physician or single group practice of physicians and conducted exclusively for patients of that physician or group practice.

      The term "institution" shall exclude all physicians' and dentists' private offices and treatment rooms in which such physicians or dentists primarily see, consult with, and treat patients.

5. "Medical facility" means any licensed general hospital, destination cancer hospital, or specialty hospital, institutional infirmary, public health center, or diagnostic and treatment center.
6. "Permit" means a permit issued by the department upon compliance with the rules and regulations of the department.
7. "Provisional permit" means a permit issued on a conditional basis for one of the following reasons:
   1. To allow a newly established institution a reasonable but limited period of time to demonstrate that its operational procedures equal standards specified by the rules and regulations of the department; or
   2. To allow an existing institution a reasonable length of time to comply with rules and regulations, provided the institution shall present a plan of improvement acceptable to the department.

      (Code 1933, § 88-1901, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1969, p. 715, § 3; Ga. L. 1973, p. 635, § 3; Ga. L. 1978, p. 1757, § 1; Code 1933, § 88-1913, enacted by Ga. L. 1980, p. 1040, § 2; Ga. L. 1982, p. 3, § 31; Ga. L. 1982, p. 864, §§ 1, 3; Ga. L. 1983, p. 3, § 22; Ga. L. 1989, p. 1566, § 2; Ga. L. 1990, p. 381, § 1; Ga. L. 1991, p. 94, § 31; Ga. L. 1993, p. 1445, § 4; Ga. L. 2002, p. 1324, § 1-5; Ga. L. 2003, p. 558, § 2; Ga. L. 2008, p. 12, § 2-8/SB 433; Ga. L. 2011, p. 227, § 11/SB 178.)

Cross references. - "Personal care home" defined, § 31-7-12 .

Conscious sedation, § 43-11-21 .

Editor's notes. - Ga. L. 1993, p. 1445, § 18.1, not codified by the General Assembly, provides: "Nothing in this Act shall be construed to repeal any provision of Chapter 5 of Title 37 of the Official Code of Georgia Annotated, the 'Community Services Act for the Mentally Retarded.' "

For application of this statute in 2020, see Executive Orders 04.14.20.01 and 05.12.20.02.

A listing of Executive Orders issued in 2020 can be found at https://gov.georgia.gov/executive-action/executive-orders/2020-executive-orders.

31-7-2. Classification of institutions.

The department shall classify institutions and adopt and promulgate rules and regulations applicable thereto according to the type of services rendered.

(Ga. L. 1946, p. 34, § 1; Ga. L. 1958, p. 322, § 1; Code 1933, § 88-1904, enacted by Ga. L. 1964, p. 499, § 1.)

31-7-2.1. Rules and regulations; availability of reports of cited deficiencies; disclosure of survey worksheets and documents.

1. The department shall adopt and promulgate such reasonable rules and regulations which in its judgment are necessary to protect the health and lives of patients and shall prescribe and set out the kind and quality of building, equipment, facilities, and institutional services which institutions shall have and use in order to properly care for their patients. Such rules and regulations shall include detailed quality standards for specific clinical services which shall be required to be met by an institution prior to offering the particular service. Such rules and regulations shall require that all nursing homes annually offer unless contraindicated, contingent on availability, an influenza virus vaccine to all medicare and Medicaid-eligible patients and private-pay patients in their facilities, in accordance with the rules and regulations established pursuant to this subsection. Such rules and regulations shall also require that all nursing homes annually offer unless contraindicated, contingent on availability, a pneumococcal bacteria vaccine to all medicare-eligible patients and all private-pay patients, 65 years of age or older, in their facilities, in accordance with the rules and regulations established pursuant to this subsection.
2. The department shall compile and distribute, upon request, to interested persons a monthly list of those nursing homes and intermediate care homes surveyed, inspected, or investigated during the month, indicating each facility for which deficiencies have been cited by the department, and indicating where reports of the cited deficiencies and information regarding any sanctions imposed can be obtained. The department shall also make available the survey reports upon written request.
3. Except as provided in Code Sections 31-8-86 and 31-5-5, all worksheets or documents prepared or compiled by department surveyors in the course of nursing home surveys shall be provided upon written request to a nursing home which has received notice of intent to impose a remedy or sanction pursuant to 42 U.S.C. Section 1396r or Code Section 31-2-8; provided, however, that the names of residents and any other information that would reveal the identities of residents and the content of resident interviews shall not be disclosed except as provided in survey protocols of the federal Centers for Medicare and Medicaid Services. The department may charge a reasonable reproduction fee as provided in Article 4 of Chapter 18 of Title 50.

   (Code 1933, § 88-1903, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1991, p. 1603, § 1; Ga. L. 1996, p. 1024, § 1; Ga. L. 2002, p. 415, § 31; Ga. L. 2004, p. 443, § 1; Ga. L. 2008, p. 12, § 2-9/SB 433; Ga. L. 2009, p. 453, § 1-9/HB 228; Ga. L. 2011, p. 705, § 4-7/HB 214.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2003, an extra "the" was deleted preceding "federal Centers for Medicare and Medicaid Services" near the end of the first sentence in subsection (c).

Pursuant to Code Section 28-9-5, in 2004, a hyphen was inserted twice between the words "private pay" and once between the words "Medicaid eligible" and the words "medicare eligible" in the second and third sentence of subsection (a).

Pursuant to Code Section 28-9-5, in 2008, "Article 4 of Chapter 18 of Title 50." was substituted for "Code Section 50-18-70 et seq." in the last sentence of subsection (c).

U.S. Code. - Requirements for nursing facilities, 42 U.S.C. § 1396r.

Law reviews. - For article on the 2011 amendment of this Code section, see 28 Ga. St. U. L. Rev. 147 (2011). For note on 1991 amendment of this Code section, see 8 Ga. St. U. L. Rev. 74 (1992).

31-7-2.2. Determination that patients or residents in an institution, community living arrangement, or treatment program are in danger; relocation of patients or residents; suspension of admissions.

1. 1. The commissioner may order the emergency relocation of patients or residents from an institution subject to licensure under this chapter, a community living arrangement subject to licensure under paragraph (8) of subsection (d) of Code Section 31-2-4, or a drug abuse treatment and education program subject to licensure under Chapter 5 of Title 26 when the commissioner has determined that the patients or residents are subject to an imminent and substantial danger.
   2. When an order is issued under this subsection, the commissioner shall provide for:
      1. Notice to the patient or resident, his or her next of kin or guardian, and his or her physician of the emergency relocation and the reasons therefor;
      2. Relocation to the nearest appropriate institution, community living arrangement, or drug abuse treatment and education program; and
      3. Other protection designed to ensure the welfare and, when possible, the desires of the patient or resident.
      4. The health, safety, security, rights, or welfare of the patients or residents cannot be adequately assured by the institution, community living arrangement, or drug abuse treatment and education program.
2. 1. The commissioner may order the emergency placement of a monitor in an institution subject to licensure under this chapter, a community living arrangement subject to licensure under paragraph (8) of subsection (d) of Code Section 31-2-4, or a drug abuse treatment and education program subject to licensure under Chapter 5 of Title 26 when one or more of the following conditions are present:

      (A) The institution, community living arrangement, or drug abuse treatment and education program is operating without a permit or a license;

      (B) The department has denied application for a permit or a license or has initiated action to revoke the existing permit or license of the institution, community living arrangement, or drug abuse treatment and education program;

      (C) The institution, community living arrangement, or drug abuse treatment and education program is closing or plans to close and adequate arrangements for relocation of the patients or residents have not been made at least 30 days before the date of closure; or

   2. A monitor may be placed, pursuant to this subsection, in an institution, community living arrangement, or drug abuse treatment and education program for no more than ten days, during which time the monitor shall observe conditions and compliance with any recommended remedial action of the department by the institution, community living arrangement, or drug abuse treatment and education program. The monitor shall report to the department. The monitor shall not assume any administrative responsibility within the institution, community living arrangement, or drug abuse treatment and education program nor shall the monitor be liable for any actions of the institution, community living arrangement, or drug abuse treatment and education program. The costs of placing a monitor in an institution, community living arrangement, or drug abuse treatment and education program shall be paid by the institution, community living arrangement, or drug abuse treatment and education program unless the order placing the monitor is determined to be invalid in a contested case proceeding under subsection (d) of this Code section, in which event the costs shall be paid by the state.
3. 1. The commissioner may order the emergency prohibition of admissions to an institution subject to licensure under this chapter, a community living arrangement subject to licensure under paragraph (8) of subsection (d) of Code Section 31-2-4, or program subject to licensure under Chapter 5 of Title 26 when such institution, community living arrangement, or drug abuse treatment and education program has failed to correct a violation of departmental permit rules or regulations within a reasonable period of time, as specified in the department's corrective order, and the violation:
      1. Could jeopardize the health and safety of the residents or patients in the institution, community living arrangement, or drug abuse treatment and education program if allowed to remain uncorrected; or
      2. Is a repeat violation over a 12 month period, which is intentional or due to gross negligence.
   2. Admission to an institution, community living arrangement, or drug abuse treatment and education program may be suspended until the violation has been corrected or until the department has determined that the institution, community living arrangement, or drug abuse treatment and education program has undertaken the action necessary to effect correction of the violation.
4. The commissioner may issue emergency orders pursuant to this Code section only if authorized by rules and regulations of the department. Unless otherwise provided in the order, an emergency order shall become effective immediately. The department shall hold a preliminary hearing within ten days following a request therefor by any institution, community living arrangement, or drug abuse treatment and education program affected by an emergency order. If at the preliminary hearing the order is determined by the department to be invalid, that order shall thereupon become void and of no effect. If at the preliminary hearing the order is determined by the department to be valid, that determination shall constitute a contested case under Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," and that order shall remain in effect until determined invalid in a proceeding regarding the contested case or until rescinded by the commissioner, whichever is earlier. For purposes of this subsection, an emergency order is valid only if the order is authorized to be issued under this Code section and rules and regulations relating thereto.
5. The powers provided by this Code section are cumulative of all other powers of the department, board, and commissioner. (Code 1981, § 31-7-2.2 , enacted by Ga. L. 1983, p. 1323, § 1; Ga. L. 2003, p. 558, § 3; Ga. L. 2009, p. 453, § 1-26/HB 228.)

Administrative Rules and Regulations. - Monitoring, suspension of admissions, or transfer of patients or residents of hospitals and related institutions, Official Compilation of the Rules and Regulations of the State of Georgia, Department of Human Services, Public Health, Chapter 290-5-44.

31-7-3. Requirements for permits to operate institutions.

1. Any person or persons responsible for the operation of any institution, or who may hereafter propose to establish and operate an institution and to provide specified clinical services, shall submit an application to the department for a permit to operate the institution and provide such services, such application to be made on forms prescribed by the department. No institution shall be operated in this state without such a permit, which shall be displayed in a conspicuous place on the premises. No clinical services shall be provided by an institution except as approved by the department in accordance with the rules and regulations established pursuant to Code Section 31-7-2.1. Failure or refusal to file an application for a permit shall constitute a violation of this chapter and shall be dealt with as provided for in Article 1 of Chapter 5 of this title. Following inspection and classification of the institution for which a permit is applied for, the department may issue or refuse to issue a permit or a provisional permit. Permits issued shall remain in force and effect until revoked or suspended; provisional permits issued shall remain in force and effect for such limited period of time as may be specified by the department. Upon conclusion of the Atlantic Cardiovascular Patient Outcomes Research Team (C-PORT) Study, the department shall consider and analyze the data and conclusions of the study and promulgate rules pursuant to Code Section 31-7-2.1 to regulate the quality of care for therapeutic cardiac catheterization. All hospitals that participated in the study and are exempt from obtaining a certificate of need based on paragraph (22) of subsection (a) of Code Section 31-6-47 shall apply for a permit to continue providing therapeutic cardiac catheterization services once the department promulgates the rules required by this Code section.
2. The department may accept the certification or accreditation of an institution by the American Osteopathy Association or a nationally recognized health care accreditation body, in accordance with specific standards, as evidence of that institution's compliance with the substantially equivalent departmental requirements for issuance or renewal of a permit or provisional permit, provided that such certification or accreditation is established prior to the issuance or renewal of such permits. The department may not require an additional departmental inspection of any institution whose certification or accreditation has been accepted by the department, except to the extent that such specific standards are less rigorous or less comprehensive than departmental requirements. Nothing contained in this Code section shall prohibit departmental inspections for violations of such standards or requirements nor shall it prohibit the revocation of or refusal to issue or renew permits, as authorized by Code Section 31-7-4, or for violation of any other applicable law or regulation pursuant thereto.
3. The department shall require a facility licensed under this article and rules and regulations adopted pursuant thereto to have a written and regularly rehearsed disaster preparedness plan, approved by the department, for staff and residents to follow in case of fire, explosion, or other emergency, including interruption of electrical power supply, gas-heating supply, and water supply. The plan shall include written procedures for personnel to follow in an emergency including care of the resident; notification of attending physician and other persons responsible for the resident; and arrangements for transportation, for hospitalization, for alternate living arrangements, for emergency energy sources, or for other appropriate services.
4. 1. When an application for licensure to operate a personal care home, as defined in subsection (a) of Code Section 31-7-12, or an assisted living community, as defined in Code Section 31-7-12.2, has been made, the department shall inform the office of the state long-term care ombudsman of the name and address of the applicant prior to issuing authority to operate or receive residents and shall provide to the ombudsman program an opportunity to provide to the department information relevant to the applicant's fitness to operate as a licensed personal care home or an assisted living community.
   2. The department may consider any information provided under this subsection, where verified by appropriate licensing procedures, in determining whether an applicant meets the requirements for licensing.
   3. The department shall promulgate regulations setting forth the procedures by which the long-term care ombudsman program shall report information to the department or its designee as required by this subsection, including a consistent format for the reporting of information, safeguards to protect confidentiality, and specified types of information which shall be routinely provided by the long-term care ombudsman program.
   4. Nothing in this subsection shall be construed to provide any authority to the long-term care ombudsman program to license or refuse to license the operation of a personal care home or an assisted living community.

      (Ga. L. 1946, p. 34, § 3; Ga. L. 1958, p. 322, § 3; Code 1933, § 88-1905, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1981, p. 920, § 1; Ga. L. 1983, p. 783, § 1; Ga. L. 1994, p. 1358, § 1; Ga. L. 2008, p. 12, § 2-10/SB 433; Ga. L. 2011, p. 227, § 12/SB 178; Ga. L. 2012, p. 337, § 2/SB 361.)

Cross references. - Certificate of need required for offering health care and exemptions, § 31-6-40 et seq.

31-7-3.1. Posting sign by hospital operating emergency room notifying individuals of legal rights in emergencies.

As a condition of obtaining or retaining the permit required by Code Section 31-7-3 to operate such institution, any hospital which operates an emergency room shall post conspicuously therein a sign notifying the public of the rights of individuals under federal or state law with respect to examination and treatment for emergency medical conditions and women in active labor.

(Code 1981, § 31-7-3.1 , enacted by Ga. L. 1990, p. 1810, § 1.)

31-7-3.2. Notice of cited deficiency and imposition of sanction.

1. A personal care home, assisted living community, nursing home, or intermediate care home licensed under this article shall give notice in the event that such facility has been cited by the department for any deficiency for which the facility has received notice of the imposition of any sanction available under federal or state laws or regulations, except where a plan of correction is the only sanction to be imposed.
2. A notice required under subsection (a) of this Code section shall be of a size and format prescribed by the department and shall contain the following:
   1. A list of each cited deficiency which has resulted in the notice being required;
   2. A description of any actions taken by or of any notices of intent to take action issued by federal or state entities as a result of such cited deficiencies;
   3. The telephone numbers of the state and community long-term care ombudsman programs; and
   4. A statement that a copy of the notice may be obtained upon written request accompanied by a self-addressed stamped envelope.
3. A notice required by subsection (a) of this Code section shall be posted at the facility giving the notice:
   1. In an area readily accessible and continuously visible to the facility's residents and their representatives;
   2. Within 14 days after the facility receives notification of imposition of a sanction for a cited deficiency which requires the notice; and
   3. Until the department has determined such cited deficiencies no longer exist, at which time the notice may be removed.
4. In addition to the posted notice required by subsection (c) of this Code section, a notice, containing the information set forth in subsection (b) of this Code section, shall also be provided by the facility upon written request.  The facility shall be responsible for mailing a copy of such notice when the written request is accompanied by a postage paid self-addressed envelope.
5. Each applicant to a facility shall receive upon written request with his application a copy of the most recent notice which has been distributed pursuant to this subsection.  The facility may inform the applicant of any corrective actions taken in response to the cited deficiencies contained in such notice.
6. In the event that the facility previously has been required to have posted or provided notice of the same cited deficiency arising from the same act, occurrence, or omission, this Code section should not be construed to require the facility to post or provide duplicate notice of such cited deficiency so long as the notice is made in a manner consistent with subsections (b) and (c) of this Code section.
7. In the case of a violation of this Code section, the department may impose administrative sanctions as otherwise provided by law in accordance with Chapter 13 of Title 50, the "Georgia Administrative Procedure Act."
8. The department may promulgate rules and regulations to implement the provisions of this Code section.
9. No violation of any regulation promulgated pursuant to the federal Nursing Home Reform Act, 42 U.S.C. Sections 1396r and 1395i-3, or any regulation included in Ga. Comp. R. & Regs. 111-8-50 or 111-8-56 or the successor of such regulations as they existed on May 12, 2015, shall constitute negligence per se; provided, however, that the court in any civil action shall take judicial notice of these regulations and admit them into evidence if found to be relevant to the harm alleged in the complaint. Nothing in this subsection shall abrogate any express cause of action authorized under law or be construed to amend or repeal any provision of the "Bill of Rights for Residents of Long-term Care Facilities" in Article 5 of Chapter 8 of this title.
10. 1. The results or findings of a federal or state survey or inspection of a nursing home facility, including any statement of deficiencies or reports, shall not be used or referenced in an advertisement or solicitation by any person or any entity, unless the advertisement or solicitation includes all of the following:
       1. The date the survey was conducted;
       2. A statement that the Department of Community Health conducts a survey of all nursing home facilities at least once every 15 months;
       3. If a finding or deficiency cited in the statement of deficiencies has been substantially corrected, a statement that the finding or deficiency has been substantially corrected and the date that the finding or deficiency was substantially corrected;
       4. The number of findings and deficiencies cited in the statement of deficiencies on the basis of the survey and a disclosure of the severity level for each finding and deficiency;
       5. The average number of findings and deficiencies cited in statements of deficiencies on the basis of surveys conducted by the department during the same calendar year as the survey used in the advertisement;
       6. A disclosure of whether each finding or deficiency caused actual bodily harm to any residents and the number of residents harmed thereby; and
       7. A statement that the advertisement is neither authorized nor endorsed by any government agency.
    2. In addition to any other remedies and damages allowed by law, a party found to have violated paragraph (1) of this subsection shall be liable for attorney fees and expenses of litigation incurred in an action to restrain or enjoin such violation; provided, however, that damages, attorney fees, and expenses of litigation shall not be recoverable against any newspaper, news outlet, or broadcaster publishing an advertisement or solicitation submitted by a third party for a fee. (Code 1981, § 31-7-3.2 , enacted by Ga. L. 1991, p. 1603, § 2; Ga. L. 2015, p. 1315, § 1/HB 342; Ga. L. 2016, p. 864, § 31/HB 737; Ga. L. 2020, p. 95, § 4/HB 987.)

The 2020 amendment, effective June 30, 2020, added "personal care home, assisted living community" and inserted a comma after nursing home near the beginning of subsection (a).

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2015, "May 12, 2015" was substituted for "the effective date of this subsection" in the first sentence of subsection (i).

Editor's notes. - Ga. L. 2015, p. 1315, § 2/HB 342, not codified by the General Assembly, provides: "This Act shall become effective upon its approval by the Governor or upon its becoming law without such approval and shall apply to all causes of actions arising on and after such date."

Law reviews. - For annual survey on trial practice and procedure, see 67 Mercer L. Rev. 257 (2015). For note on 1991 enactment of this Code section, see 8 Ga. St. U. L. Rev. 74 (1992).

31-7-3.3. "Excluded party" defined; liability; notice; dismissal; other procedural factors.

1. As used in this Code section, the term "excluded party" means a person or entity that neither performs, has the duty to perform, nor controls the performance of any of the following functions at or on behalf of a nursing home or intermediate care home where alleged injuries occurred:
   1. Providing management, operation, or administrative services for such home;
   2. Hiring or firing of the administrator, director of nursing, or other staff working at such home;
   3. Setting or controlling the budget of such home;
   4. Staffing or determining the level of staff at such home;
   5. Providing direct care, treatment, or services to the residents of such home;
   6. Making decisions regarding the care, treatment, or services provided to residents at such home; or
   7. Adopting, implementing, or enforcing the policies and procedures for such home.
2. Except as otherwise provided by law, the mere ownership of an entity shall not, by itself, create the duty to perform the functions listed in subsection (a) of this Code section.
3. An excluded party shall not be named in a civil action that alleges its direct or vicarious liability for the personal injury or death of one or more residents of a nursing home or intermediate care home or a violation of residents' rights at such home under Article 5 of Chapter 8 of this title.
4. Any person or entity named as a defendant in a civil action or arbitration, that claims to be an excluded party, may serve a notice of such claim upon the plaintiff. Such notice shall be sent to counsel for the plaintiff by certified mail, return receipt requested, or, if the plaintiff does not have an attorney, to the plaintiff personally via certified mail, return receipt requested. Such notice shall be served after the discovery period begins under applicable law for the case but not later than 30 days after such discovery period begins.
5. If, after the expiration of 90 days from the date the notice described in subsection (d) of this Code section is received, the plaintiff does not agree to a dismissal without prejudice of such defendant claiming to be an excluded party, and:
   1. The court later determines that there is no genuine issue of material fact as to whether such defendant is an excluded party, grants summary judgment to such defendant as to this issue, and such order becomes final after any appeal; or
   2. If an arbitrator enters judgment for such defendant as to this issue and determines that there was not a good faith basis in law and fact for the plaintiff's claim that such defendant was not an excluded party and such order becomes final after any appeal,

      then such finding by an arbitrator or final judgment by a court shall be deemed a finding that the plaintiff's claim against such defendant was substantially frivolous, substantially groundless, or substantially vexatious. Upon such a final judgment or finding, such excluded party shall be entitled to an award of reasonable and necessary attorneys' fees and expenses of litigation upon the filing of a motion. The court or arbitrator shall award only such reasonable and necessary attorneys' fees and expenses of litigation as the court or arbitrator determines were related to the defense of only such excluded party and not to the defense of other defendants in such action, unless otherwise authorized by law. Such attorneys' fees and expenses so awarded shall be assessed against the party asserting such claim, against such party's attorney, or against both in such manner as is just.

6. In the event that the plaintiff prevails on any claim against a defendant claiming to be an excluded party and if the court or an arbitrator determines that there was not a good faith basis in law and fact for the defendant's claim that such defendant was an excluded party, and such order becomes final after appeal, then such judgment by a court or arbitrator shall be deemed a finding that the contention by such defendant that it was an excluded party was substantially frivolous, substantially groundless, or substantially vexatious. Upon such a final judgment or finding, the plaintiff shall be entitled to an award of reasonable and necessary attorneys' fees and expenses of litigation upon the filing of a motion. The court or arbitrator shall award only such reasonable and necessary attorneys' fees and expenses of litigation that were incurred in the pursuit of the action against the defendant claiming to be an excluded party, and the plaintiff shall not be entitled to an award of reasonable and necessary attorneys' fees and expenses of litigation that were incurred in the pursuit of the action against other defendants, unless otherwise authorized by law. Such attorneys' fees and expenses so awarded shall be assessed against the party asserting such claim, against such party's attorney, or against both in such manner as is just.
7. Notwithstanding Code Section 51-7-85, subsections (e) and (f) of this Code section shall be in addition to and shall not limit a party's right to pursue a recovery pursuant to Code Section 9-15-14 or Article 5 of Chapter 7 of Title 51.
8. The time period set forth in subsection (e) of this Code section may be extended by agreement of the parties or by order of the court; provided, however, that if during such time period any party files a motion to stay the case or a motion to compel arbitration, such time period shall be extended for 30 days following the date the court rules on such motion; and provided, further, that if any party files a motion to compel discovery, such period shall be extended until 30 days following the date that the party complies with the court's order to produce discovery, whichever is later.
9. A defendant which is a licensee shall not identify an excluded party as a potentially at-fault nonparty for purposes of apportionment under Code Section 51-12-33 , unless such nonparty has entered into a settlement agreement with the plaintiff or claimant. (Code 1981, § 31-7-3.3 , enacted by Ga. L. 2016, p. 550, § 1/HB 920; Ga. L. 2017, p. 774, § 31/HB 323.)

The 2017 amendment, effective May 9, 2017, part of an Act to revise, modernize, and correct the Code, substituted "its direct" for "their direct" near the beginning of subsection (c); substituted "that claims" for "who claims" in the first sentence of subsection (d); and substituted "such claim," for "such claim, or" near the end of the last sentence of the ending undesignated paragraph in subsection (e) and near the middle of the last sentence of subsection (f).

Editor's notes. - Ga. L. 2016, p. 550, § 2/HB 920, not codified by the General Assembly, makes this Code section applicable to any claim filed on or after July 1, 2016.

31-7-3.4. Carrying of liability insurance or establishment of self-insurance trust as condition precedent to obtaining or maintaining permit.

1. As used in this Code section, the term "nursing home claim" means a claim alleging direct or vicarious liability for the personal injury or death of one or more residents of a nursing home or intermediate care home or a violation of residents' rights at such home under Article 5 of Chapter 8 of this title.
2. 1. As a condition precedent to obtaining or maintaining a permit under this article to operate a nursing home or intermediate care home, a licensee shall carry or be covered by liability insurance coverages or establish or have established for its benefit a self-insurance trust for a nursing home claim.
   2. If a licensee fails to carry or be covered by liability insurance coverages or establish or have established for its benefit a self-insurance trust for a nursing home claim, the department shall provide notice to such licensee of its noncompliance and allow such licensee 60 days in which to comply. A licensee's failure to maintain such coverage or establish such trust shall result in the department:
      1. Revoking such licensee's permit issued pursuant to this article to operate the nursing home or intermediate care home;
      2. Denying any application to renew such permit; and
      3. Denying any application for a change of ownership of the nursing home or intermediate care home. (Code 1981, § 31-7-3.4 , enacted by Ga. L. 2016, p. 550, § 1/HB 920.)

Editor's notes. - Ga. L. 2016, p. 550, § 2/HB 920, not codified by the General Assembly, makes this Code section appli- cable to any claim filed on or after July 1, 2016.

31-7-4. Denial or revocation of permits.

The department may refuse to grant a permit as provided for in Code Section 31-7-3 for the operation of any institution that does not fulfill the minimum requirements which the department may prescribe by rules and regulations, may revoke a permit which has been issued if an institution violates any of such rules and regulations, and may revoke a portion of a permit which has been issued as it relates to a specific clinical service if the quality standards established by the department pursuant to Code Section 31-7-2.1 for such clinical service are not met; provided, however, that before any order is entered refusing a permit applied for or revoking a permit previously granted, the applicant or permit holder, as the case may be, shall be afforded an opportunity for a hearing as provided for in Article 1 of Chapter 5 of this title. All appeals from such orders and all rights of enforcement by injunction shall be governed by Article 1 of Chapter 5 of this title.

(Ga. L. 1946, p. 34, §§ 3, 4; Ga. L. 1958, p. 322, § 3; Code 1933, § 88-1906, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 2008, p. 12, § 2-11/SB 433.)

31-7-5. Exemptions from permit requirements; application of this chapter to federally operated institutions.

Code Section 31-7-3 shall not apply to the offices of physicians or others practicing the healing arts unless the facilities and services described in paragraph (4) of Code Section 31-7-1 are provided therein; nor shall this chapter apply to institutions operated exclusively by the federal government or by any of its agencies.

(Ga. L. 1946, p. 34, § 6; Code 1933, § 88-1907, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 2008, p. 12, § 2-12/SB 433.)

31-7-6. Provision of data for research purposes by organizations rendering patient care; liability of providers of data; use of data; confidentiality.

1. Any hospital, health care facility, medical or skilled nursing home, or other organization rendering patient care may provide information, interviews, reports, statements, memoranda, or other data relating to the condition and treatment of any person to research groups approved by the medical staff of the institution involved, to governmental health agencies, medical associations and societies, or to any in-hospital medical staff committee, to be used in the course of any study for the purpose of reducing rates of morbidity or mortality; and no liability of any kind or character for damages or other relief shall arise or be enforced against any person or organization by reason of having provided such information or material, or by reason of having released or published the findings and conclusions of such groups to advance medical research or medical education or to achieve the most effective use of health manpower and facilities, or by reason of having released or published generally a summary of such studies.
2. The research groups approved by the medical staff of the institution involved, governmental health agencies, medical associations and societies, or any in-hospital medical staff committee shall use or publish material described in subsection (a) of this Code section only for the purpose of advancing medical research or medical education, or to achieve the most effective use of health manpower and facilities, in the interest of reducing rates of morbidity or mortality, except that a summary of such studies may be released by any such group for general publication.
3. In all events the identity of any person whose condition or treatment has been studied pursuant to this Code section shall be confidential and shall not be revealed under any circumstances.

   (Code 1933, §§ 88-1908, 88-1909, 88-1910, enacted by Ga. L. 1966, p. 310, §§ 1-3.)

31-7-7. Refusal or revocation by public hospital of staff privileges.

1. Whenever any licensed doctor of medicine, doctor of podiatric medicine, doctor of osteopathic medicine, or doctor of dentistry shall make application for permission to treat patients in any hospital owned or operated by the state, any political subdivision thereof, or any municipality, the hospital shall act in a nondiscriminatory manner upon such application expeditiously and without unnecessary delay considering the applicant on the basis of the applicant's demonstrated training, experience, competence, and availability and reasonable objectives, including, but not limited to, the appropriate utilization of hospital facilities; but in no event shall final action thereon be taken later than 90 days following receipt of the application; provided, however, whenever the applicant is licensed by any governmental entity outside the continental limits of the United States, the hospital shall have 120 days to take action following receipt of the application. This subsection shall apply solely to applications by licensed doctors of medicine, doctors of podiatric medicine, doctors of osteopathic medicine, and doctors of dentistry who are not members of the staff of the hospital in which privileges are sought at the time an application is submitted and by those not privileged, at such time, to practice in such hospital under a previous grant of privileges. The provisions of this subsection shall not be construed so as to repeal the provisions of Code Section 31-7-15, to mandate hospitals to offer or provide any type of service or services not otherwise offered, or to prohibit a hospital with a clinical training program affiliated with a school of medicine from requiring an applicant to have a faculty teaching appointment as a condition of eligibility.
2. Whenever any hospital owned or operated by the state, any political subdivision thereof, or any municipality shall refuse to grant a licensed doctor of medicine, doctor of podiatric medicine, doctor of osteopathic medicine, or doctor of dentistry the privilege of treating patients in the hospital, wholly or in part, or revoke the privilege of such licensed medical practitioner for treating patients in such hospital, wholly or in part, the hospital shall furnish to the licensed medical practitioner whose privilege has been refused or revoked, within ten days of such action, a written statement of the reasons therefor.
3. The provisions of this Code section shall not be construed to mandate such hospital to grant or to prohibit such hospital from granting staff privileges to other licensed practitioners of the healing arts who are otherwise qualified for staff privileges pursuant to the bylaws of the governing body of the hospital and, in addition, shall not be construed to modify or restrict the rights of health service provider psychologists to be treated in a nondiscriminatory manner as provided in Code Sections 31-7-161 and 31-7-164.

   (Code 1933, § 88-1911, enacted by Ga. L. 1976, p. 326, § 1; Ga. L. 1978, p. 1969, § 1; Ga. L. 1984, p. 967, § 1; Ga. L. 1990, p. 561, § 1.)

31-7-7.1. Denial of staff privileges based upon license, board certification, or membership in professional association.

Notwithstanding the provisions of Code Section 31-7-7, if a hospital offers or provides a service which is within the scope of practice of a person licensed as a doctor of podiatric medicine, doctor of osteopathic medicine, or doctor of dentistry, that hospital may not deny to any such licensee staff privileges at such hospital based solely upon that person's license, board certification, or specialty membership in a professional association.

(Code 1981, § 31-7-7.1 , enacted by Ga. L. 1997, p. 911, § 1; Ga. L. 1998, p. 548, § 1.)

31-7-8. Reports of disciplinary actions against persons authorized to practice professions under Chapter 11, 34, or 35 of Title 43.

1. The hospital administrator or chief executive officer of each institution subject to this chapter shall submit a written report to the appropriate licensing board when a person who is authorized to practice medicine, osteopathy, podiatry, or dentistry in this state under Chapter 34, Chapter 35, or Chapter 11, respectively, of Title 43 and who is a member of the medical staff at the institution, has medical staff privileges at the institution, or has applied for medical staff privileges at the institution has his medical staff privileges denied, restricted, or revoked for any reason involving the medical care given his patient.  Each such administrator or officer shall also report to the appropriate licensing board resignations from practice in that institution by persons licensed under Chapter 34, Chapter 35, or Chapter 11 of Title 43.  This Code section shall not require reports of temporary suspensions for failure to comply with medical record regulations.
2. The written report required by subsection (a) of this Code section shall be made within 20 working days following final action by the institution on the restriction, denial, or revocation of medical staff privileges. The results of any legal appeal of such action shall be reported within 20 working days following a final court decision on such appeal.
3. The report required by this Code section shall contain a statement detailing the nature of the restriction, denial, or revocation of medical staff privileges, the date such action was taken, and the reasons for such action. If the action is a voluntary resignation or restriction of medical staff privileges which was the result of action initiated by the institution, the report shall contain the circumstances involved therein.
4. There shall be no civil or criminal liability on the part of, and no cause of action for damages shall arise against, any hospital administrator, chief executive officer, or other authorized person who in good faith complies with this Code section.
5. Except as provided in this subsection and Chapter 34A of Title 43, information contained in any report made to the appropriate licensing board pursuant to this Code section shall be confidential and shall not be disclosed to the public. Access to such reports shall be limited to members of the appropriate licensing board or its staff for their use and to interested institutions for their use in the review of medical staff privileges at the institution.
6. The failure of an institution to comply with this Code section shall be grounds for the denial, refusal to renew, or revocation of the permit for the operation of the institution issued pursuant to this chapter.

   (Code 1933, § 88-1912, enacted by Ga. L. 1977, p. 257, § 1; Ga. L. 1983, p. 882, § 1; Ga. L. 1990, p. 561, § 2; Ga. L. 2001, p. 192, § 1.)

Law reviews. - For note on the 2001 amendment to this Code section, see 18 Ga. St. U. L. Rev. 249 (2001).

31-7-9. Reports by physicians and other personnel of nonaccidental injuries to patients; immunity from liability.

1. As used in this Code section, the term "medical facility" includes, without being limited to, an ambulatory surgical treatment center defined in subparagraph (C) of paragraph (4) of Code Section 31-7-1 and a freestanding imaging center defined in subparagraph (G) of paragraph (4) of Code Section 31-7-1.
2. Any:
   1. Physician, including any doctor of medicine licensed to practice under the laws of this state;
   2. Licensed registered nurse employed by a medical facility;
   3. Security personnel employed by a medical facility; or
   4. Other personnel employed by a medical facility whose employment duties involve the care and treatment of patients therein

      having cause to believe that a patient has had physical injury or injuries inflicted upon him other than by accidental means shall report or cause reports to be made in accordance with this Code section.

3. An oral report shall be made immediately by telephone or otherwise and shall be followed by a report in writing, if requested, to the person in charge of the medical facility or his designated delegate. The person in charge of the medical facility or his designated delegate shall then notify the local law enforcement agency having primary jurisdiction in the area in which the medical facility is located of the contents of the report. The report shall contain the name and address of the patient, the nature and extent of the patient's injuries, and any other information that the reporting person believes might be helpful in establishing the cause of the injuries and the identity of the perpetrator.
4. Any person or persons participating in the making of a report or causing a report to be made to the appropriate police authority pursuant to this Code section or participating in any judicial proceeding or any other proceeding resulting therefrom shall in so doing be immune from any civil liability that might otherwise be incurred or imposed, providing such participation pursuant to this Code section shall be in good faith.

   (Code 1933, § 88-1913, enacted by Ga. L. 1980, p. 1040, § 2; Ga. L. 1982, p. 1249, §§ 1, 2; Ga. L. 1985, p. 898, § 1; Ga. L. 2008, p. 12, § 2-13/SB 433.)

Law reviews. - For article, "Hospital Liability for Physician Negligence in Georgia: A Realistic Approach," see 37 Mercer L. Rev. 701 (1986).

31-7-10. Certification and approval of hospitals eligible to render service under a group nonprofit hospital insurance plan; supervision of such hospitals; withdrawal of approval.

The department shall (1) certify and approve hospitals applying therefor which may be found to be eligible to render hospital service under any group nonprofit hospital insurance plan, which plan may be approved and become effective, and (2) supervise the services rendered by hospitals operating under such plan, with authority to withdraw approval from any hospital which subsequently may, under rules and regulations of the board, become ineligible for rendering such services, provided that, in fixing rules and regulations in this connection or in enforcing such rules, hospitals interested therein shall be given opportunity to be heard.

(Ga. L. 1937, p. 355, § 6.)

Law reviews. - For article, "Entity and Identity," see 60 Emory L.J. 1257 (2011).

31-7-11. Written summary of hospital service charge rates.

1. Any hospital shall, upon request, provide a written summary of certain hospital and related services charges, including but not limited to:
   1. The average total charges per patient day for the facility's previous fiscal year;
   2. The daily rate for a room in said hospital, which rate shall include an explanation of the categories of services included in said charge;
   3. Anesthesia charges, with an explanation of the categories of services included in this charge;
   4. Operating room charges;
   5. Recovery room charges;
   6. Intravenous administration charges;
   7. Emergency room charges, with an explanation of the categories of services included in the charge;
   8. The charge for the patient care kit or admission kit or other such items furnished to the patient on admission;
   9. Charges for specific routine tests, including but not limited to a complete blood count, urinalysis, and chest X-ray; and
   10. Charges for specific special tests, including but not limited to electrocardiogram, electroencephalogram, CAT scan of the head, CAT scan of liver, CAT scan of lungs, CAT scan of skeletal system, spirometry, and complete pulmonary function.

       Such written summary of charges shall be composed in a simple clear fashion so as to enable consumers to compare hospital charges and make cost-effective decisions in the purchase of hospital services.

2. The department shall adopt rules and regulations to implement the provisions of this Code section and shall implement such regulations as provided in Code Section 31-7-2.1 . (Code 1981, § 31-7-11 , enacted by Ga. L. 1983, p. 1307, § 1; Ga. L. 1984, p. 22, § 31.)

Code Commission notes. - Code Section 31-7-11 was added to the Code by both Ga. L. 1983, p. 1307, § 1 and Ga. L. 1984, p. 778, § 1. The former is set out above and the latter has been redesignated as Code Section 31-7-13 pursuant to the authority granted in Code Section 28-9-5.

Law reviews. - For article, "Price Transparency and Incomplete Contracts in Health Care," see 67 Emory L.J. 1 (2017).

31-7-12. "Personal care home" and "personal services" defined; licensure and registration; inspection by local boards; fees; investigations; waiver, variance, or exemption.

1. As used in this Code section, the term:
   1. "Direct care staff person" means any employee, facility volunteer, or contract staff who provides to residents:
      1. Any personal services, including but not limited to, medication administration or assistance, assistance with ambulation and transfer, and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting; or
      2. Any other limited nursing services, as defined in subsection (b) of Code Section 31-7-12.2.
   2. "Personal care home" means any dwelling, whether operated for profit or not, which undertakes through its ownership or management to provide or arrange for the provision of housing, food service, and one or more personal services for two or more adults who are not related to the owner or administrator by blood or marriage. This term shall not include host homes, as defined in paragraph (18) of subsection (b) of Code Section 37-1-20.
   3. "Personal services" includes, but is not limited to, individual assistance with or supervision of self-administered medication and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting. Personal services shall not include medical, nursing, or health services; provided, however, that the department shall be authorized to grant a waiver of this provision in the same manner as provided for in Code Section 31-7-12.3 for the waiver of rules and regulations and in the same manner and only to the same extent as granted on or before June 30, 2011.
2. All personal care homes shall be licensed as provided for in Code Section 31-7-3, except that, in lieu of licensure, the department may require persons who operate personal care homes with two or three beds for nonfamily adults to comply with registration requirements delineated by the department. Such registration requirements within this category shall authorize the department to promulgate pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," reasonable standards to protect the health, safety, and welfare of the occupants of such personal care homes.
3. Upon the designation by the department and with the consent of county boards of health, such boards may act as agents to the department in performing inspections and other authorized functions regarding personal care homes licensed under this chapter. With approval of the department, county boards of health may establish inspection fees to defray part of the costs of inspections performed for the department.
4. The state ombudsman or community ombudsman, on that ombudsman's initiative or in response to complaints made by or on behalf of residents of a registered or licensed personal care home, may conduct investigations in matters within the ombudsman's powers and duties.
5. The department shall promulgate procedures to govern the waiver, variance, and exemption process related to personal care homes pursuant to Chapter 2 of this title. Such procedures shall include published, measurable criteria for the decision process, shall take into account the need for protection of public and individual health, care, and safety, and shall afford an opportunity for public input into the process.
6. On and after July 1, 2021, personal care homes with 25 or more beds shall be required to meet the following staffing and training requirements:
   1. Ensure that each direct care staff person receives initial and annual training covering topics specified by the department to ensure a demonstrated knowledge and understanding of caring for elderly and disabled adults; and
   2. Maintain an average monthly minimum on-site staffing ratio of one direct care staff person for every 15 residents during all waking hours and one direct care staff person for every 20 residents during all nonwaking hours; provided, however, that either such ratio is adequate to meet the needs of the residents.
7. On and after July 1, 2021, personal care homes with 25 or more beds shall be required to meet the following financial stability requirements:
   1. Upon initial application for licensure, provide a financial stability affidavit to the department from a certified public accountant affirming the applicant's ability to operate as a going concern for the next two years;
   2. Provide a minimum of 60 days' written notice to the department and all residents of any impending bankruptcy or property eviction that may force discharge or relocation of residents or otherwise adversely impact the provision of safe care and oversight; and
   3. Provide a minimum of 14 days' written notice to the department and all residents of any impending change of ownership that may force discharge or relocation of residents or otherwise adversely impact the provision of safe care and oversight.
8. 1. A personal care home with 25 or more beds which operates a memory care center in its facility may employ certified medication aides for the purpose of performing the technical aspects of the administration of certain medications in accordance with this subsection. Any such personal care home may utilize certified medication aides in its memory care center and anywhere in the same building in which the memory care center is located. A personal care home that employs one or more certified medication aides must have a safe medication and treatment administration system that meets all the requirements of this subsection.
   2. A personal care home may not employ an individual as a medication aide unless such individual is listed in the medication aide registry established by the department pursuant to paragraph (2) of subsection (g) of Code Section 31-7-12 .2 in good standing. An applicant for certification as a medication aide shall meet the qualifications contained in paragraph (3) of subsection (g) of Code Section 31-7-12 .2.
   3. A personal care home shall annually conduct a comprehensive clinical skills competency review of each medication aide employed by the personal care home.
   4. A medication aide who meets the criteria established in this subsection shall be permitted to perform the following tasks in a personal care home in accordance with the written instructions of a physician:
      1. Administer physician ordered oral, ophthalmic, topical, otic, nasal, vaginal, and rectal medications;
      2. Administer insulin, epinephrine, and B12 pursuant to physician direction and protocol;
      3. Administer medication via a metered dose inhaler;
      4. Conduct finger stick blood glucose testing following established protocol;
      5. Administer a commercially prepared disposable enema as ordered by a physician;
      6. Assist residents in the supervision of self-administration of medication; and
      7. Administer liquid morphine to a resident of the personal care home who is the patient of a licensed hospice, pursuant to a hospice physician's written order that contains specific instructions for indication, dosage, frequency, and route of administration, provided that the licensed hospice consents to the use and administration of liquid morphine as described in this subparagraph. The medication aide shall observe and document the resident's need for all "as needed" (PRN) liquid morphine in such resident's record and such indications of need may include verbalizations of pain, groaning, grimacing, or restlessness. The initial dose of any liquid morphine administered pursuant to this subparagraph shall be administered and assessed by a licensed hospice health care professional to observe and address any adverse reactions to such medication. The personal care home shall ensure that any medication aides who will be administering liquid morphine to any hospice patients in such personal care home pursuant to this subparagraph receive adequate training from a licensed hospice on the safe and proper administration of liquid morphine prior to such administration and on an annual basis thereafter. The personal care home shall maintain documentation of all training provided and shall adhere to all security and storage requirements for liquid morphine required under state and federal law, including but not limited to, any rules promulgated by the department. Notwithstanding the foregoing, the supply of liquid morphine on-site at the personal care home shall be limited to no more than 50 ml for each hospice patient in the personal care home and shall only be administered under limited circumstances when a licensed hospice health care professional is not otherwise available. The department shall promulgate rules and regulations to implement this subparagraph.
   5. A medication aide shall record in the medication administration record all medications that such medication aide has personally administered to a resident of a personal care home and any refusal of a resident to take a medication. A medication aide shall observe a resident to whom medication has been administered and shall report any changes in the condition of such resident to the personal representative or legal surrogate of such resident.
   6. All medication administered by a medication aide in accordance with this subsection shall be in unit or multidose packaging.
   7. A personal care home that employs one or more medication aides to administer medications in accordance with this subsection shall secure the services of a licensed pharmacist to perform the following duties:
      1. Perform a quarterly review of the drug regimen of each resident of the personal care home and report any irregularities to the personal care home administrator;
      2. Remove for proper disposal any drugs that are expired, discontinued, in a deteriorated condition, or when the resident for whom such drugs were ordered is no longer a resident;
      3. Establish or review policies and procedures for safe and effective drug therapy, distribution, use, and control; and
      4. Monitor compliance with established policies and procedures for medication handling and storage.
   8. A personal care home that employs one or more medication aides to administer medications in accordance with this subsection shall ensure that each medication aide receives ongoing medication training as prescribed by the department. A registered professional nurse or licensed pharmacist shall conduct random medication administration observations on a quarterly basis and report any issues to the personal care home administrator. (Code 1981, § 31-7-11 , enacted by Ga. L. 1983, p. 1323, § 1.1; Code 1981, § 31-7-12, as redesignated by Ga. L. 1984, p. 22, § 31; Ga. L. 1984, p. 649, § 1; Ga. L. 1985, p. 952, § 1; Ga. L. 1988, p. 13, § 31; Ga. L. 1992, p. 1392, § 1; Ga. L. 1993, p. 317, § 1; Ga. L. 2008, p. 263, § 1/SB 469; Ga. L. 2009, p. 453, § 1-27/HB 228; Ga. L. 2011, p. 227, § 13/SB 178; Ga. L. 2020, p. 95, § 5/HB 987.)

The 2020 amendment, effective June 30, 2020, added paragraph (a)(1); redesignated former paragraphs (a)(1) and (a)(2) as present paragraphs (a)(2) and (a)(3), respectively; and added subsections (f) - (h).

Code Commission notes. - Code Section 31-7-11 was added to the Code by both Ga. L. 1983, p. 1307, § 1 and Ga. L. 1983, p. 1323, § 1.1. The latter section was redesignated as Code Section 31-7-12 by Ga. L. 1984, p. 22, § 31, effective February 3, 1984, pursuant to the authority granted in Code Section 28-9-5.

31-7-12.1. Unlicensed personal care home; civil penalties; negligence per se for certain legal claims; declared nuisance dangerous to public health, safety, and welfare; criminal sanctions.

1. A facility shall be deemed to be an "unlicensed personal care home" if it is unlicensed and not exempt from licensure and:
   1. The facility is providing personal services and is operating as a personal care home as those terms are defined in Code Section 31-7-12;
   2. The facility is held out as or represented as providing personal services and operating as a personal care home as those terms are defined in Code Section 31-7-12; or
   3. The facility represents itself as a licensed personal care home.
2. Any unlicensed personal care home shall be assessed by the department, after opportunity for hearing in accordance with the provisions of Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," a civil penalty in the amount of $100.00 per bed per day for each day of violation of subsection (b) of Code Section 31-7-12. The department shall send a notice by certified mail or statutory overnight delivery stating that licensure is required and the department's intent to impose a civil penalty. Such notice shall be deemed to be constructively received on the date of the first attempt to deliver such notice by the United States Postal Service. The department shall take no action to collect such civil penalty until after opportunity for a hearing.
3. In addition to other remedies available to the department, the civil penalty authorized by subsection (b) of this Code section shall be doubled if the owner or operator continues to operate the unlicensed personal care home, after receipt of notice pursuant to subsection (b) of this Code section.
4. The owner or operator of a personal care home who is assessed a civil penalty in accordance with this Code section may have review of such civil penalty by appeal to the superior court in the county in which the action arose or to the Superior Court of Fulton County in accordance with the provisions of Code Section 31-5-3.
5. In addition to the sanctions authorized herein, an unlicensed personal care home shall be deemed to be negligent per se in the event of any claim for personal injury or wrongful death of a resident.
6. It is declared that the owning or operating of an unlicensed personal care home in this state constitutes a nuisance dangerous to the public health, safety, and welfare. The commissioner or the district attorney of the judicial circuit in which such unlicensed personal care home is located may file a petition to abate such nuisance as provided in Chapter 2 of Title 41.
7. Upon the designation by the department and with the consent of any local or state law enforcement agency, and subject to a written memorandum of understanding between the department and such agencies, Georgia Peace Officer Standards and Training certified investigators of such law enforcement agencies may act as agents of the department in conducting inspections of unlicensed personal care homes required to be licensed under this chapter. Such investigations shall be limited to instances where a law enforcement agency is performing law enforcement duties and has consent or a warrant to enter the home. Law enforcement agencies shall not be authorized to recoup any of the costs of inspections performed pursuant to this subsection from the department.
8. Any person who owns or operates a personal care home in violation of subsection (b) of Code Section 31-7-12 shall be guilty of a misdemeanor for a first violation, unless such violation is in conjunction with a violation of Article 8 of Chapter 5 of Title 16, in which case such person shall be guilty of a felony and, upon conviction, shall be punished by imprisonment for not less than one nor more than five years. Upon conviction for a second or subsequent such violation, such person shall be guilty of a felony and, upon conviction, shall be punished by imprisonment for not less than one nor more than ten years. (Code 1981, § 31-7-12 .1, enacted by Ga. L. 1994, p. 461, § 1; Ga. L. 2000, p. 1589, § 3; Ga. L. 2011, p. 227, § 13A/SB 178; Ga. L. 2012, p. 351, § 3/HB 1110; Ga. L. 2014, p. 682, § 1/HB 899; Ga. L. 2019, p. 81, § 7/HB 424.)

The 2019 amendment, effective April 18, 2019, added subsection (g); redesignated former subsection (g) as present subsection (h); and substituted "a violation of Article 8 of Chapter 5 of Title 16" for "abuse, neglect, or exploitation as defined in Code Section 30-5-3" in the middle of the first sentence of subsection (h).

Editor's notes. - Ga. L. 2000, p. 1589, § 16, not codified by the General Assembly, provided that the 2000 amendment was applicable to notices delivered on or after July 1, 2000.

31-7-12.2. Regulation and licensing of assisted living communities; legislative intent; definitions; procedures; requirements for medication aides.

1. It is the intention of the General Assembly to establish a new licensure category of long-term care provider which shall be referred to as "assisted living community." An assisted living community shall be authorized, in accordance with this Code section, to provide certain services that are beyond the scope of services that a personal care home is authorized to provide.
2. As used in this Code section, the term:
   1. "Ambulatory" means the ability to move from place to place by walking, either unaided or aided by a prosthesis, brace, cane, crutches, walker, or hand rails, or by propelling a wheelchair and to respond to an emergency condition, whether caused by fire or otherwise, and escape with minimal human assistance using the normal means of egress.
   2. "Assisted living care" includes:
      1. Personal services, which includes, but is not limited to, individual assistance with or supervision of self-administered medication and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting;
      2. The administration of medications by a medication aide in accordance with this Code section;
      3. The provision of assisted self-preservation in accordance with this Code section; and
      4. The provision of limited nursing services.
   3. "Assisted living community" means a personal care home with a minimum of 25 beds that is licensed as an assisted living community pursuant to Code Section 31-7-3.
   4. "Assisted self-preservation" means the capacity of a resident to be evacuated from an assisted living community, to a designated point of safety and within an established period of time as determined by the office of Safety Fire Commissioner. Assisted self-preservation is a function of all of the following:
      1. The condition of the individual;
      2. The assistance that is available to be provided to the individual by the staff of the assisted living community; and
      3. The construction of the building in which the assisted living community is housed, including whether such building meets the state fire safety requirements applicable to an existing health care occupancy.
   5. "Continuous medical or nursing care" means medical or nursing care required other than on a periodic basis or for a short-term illness.
   6. "Direct care staff person" means any employee, facility volunteer, or contract staff who provides to residents:
      1. Any personal services, including but not limited to, medication administration or assistance, assistance with ambulation and transfer, and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting; or
      2. Any other limited nursing services.
   7. "Limited nursing services" means the assessment of the physical, mental, and emotional status to determine the appropriate level of care for an individual; the performance of health maintenance activities, as defined in division (a)(9)(C)(ii) of Code Section 43-26-12; and the provision of any nursing care within the direct care staff person's scope of practice that can be completed within seven days or intermittently.
3. An assisted living community shall not admit or retain an individual who is not ambulatory unless the individual is capable of assisted self-preservation. In the event that the department determines that one or more residents of an assisted living community are not capable of assisted self-preservation due to the condition of the resident, the capabilities of the staff of the assisted living community, the construction of the building in which the assisted living community is housed, or a combination of these factors, the department shall have the authority to consider any of the following actions:
   1. An increase in the staffing of the assisted living community to a level that is sufficient to ensure that each resident is capable of assisted self-preservation;
   2. A change in the staffing assignments of the assisted living community if such change would ensure that each resident is capable of assisted self-preservation;
   3. A change in rooms or the location of residents as necessary to ensure that each resident is capable of assisted self-preservation;
   4. The utilization of any specialized equipment that would ensure that each resident is capable of assisted self-preservation. For purposes of this paragraph, specialized equipment shall only include a prosthesis, brace, cane, crutches, walker, hand rails, and a wheelchair;
   5. A cessation in the further admission of individuals who are not ambulatory until such time that the assisted living community has taken actions necessary to ensure that all residents are capable of assisted self-preservation;
   6. The transfer or discharge of any resident who is not capable of assisted self-preservation; and
   7. Any action set forth in Code Section 31-2-8.
4. An assisted living community shall maintain a current list of all residents who are not ambulatory but who are capable of assisted self-preservation. The list shall be provided upon request to the department and maintained at all times by the assisted living community.
5. An assisted living community shall maintain fire detection and prevention equipment, including visual signals with alarms for hearing impaired residents, in accordance with manufacturer instructions and the requirements of the Office of the Safety Fire Commissioner.
6. An assisted living community shall not admit or retain an individual who is in need of continuous medical or nursing care. Other than as permitted by a medication aide pursuant to paragraph (7) of subsection (g) of this Code section or for limited nursing services provided by a registered professional nurse or licensed practical nurse pursuant to subparagraph (b)(2)(D) of this Code section, medical, nursing, or health services required on a periodic basis, or for short-term illness, shall not be provided as services of an assisted living community. When such services are required, they shall be purchased by the resident or the resident's representative or legal surrogate, if any, from appropriate providers managed independently from the assisted living community. An assisted living community may assist in arranging for such services, but not in the provision of such services.
7. 1. An assisted living community may employ certified medication aides for the purpose of performing the technical aspects of the administration of certain medications in accordance with this subsection. An assisted living community that employs one or more certified medication aides must have a safe medication and treatment administration system that meets all the requirements of this subsection.
   2. The department shall establish and maintain a medication aide registry containing the names of each individual in Georgia who is certified by the department as a medication aide. An assisted living community may not employ an individual as a medication aide unless such individual is listed in the medication aide registry in good standing.
   3. An applicant for certification as a medication aide shall meet the following qualifications:
      1. Be a Georgia certified nurse aide with current certification in good standing;
      2. Have successfully completed a state approved medication aide training program administered by a Georgia licensed registered nurse, pharmacist, or physician;
      3. Have successfully passed, with a minimum passing score of 80 percent, a written competency examination; and
      4. Have demonstrated the requisite clinical skills to serve as a medication aide in accordance with a standardized checklist developed by the department.
   4. A record of the successful completion of the written competency examination and clinical skills standardized checklist by an applicant for certification as a medication aide shall be included in the medication aide registry within 30 business days of evaluation. Each candidate for certification as a medication aide shall have the opportunity to take the written competency examination three times before being required to retake and successfully complete the medication aide training program.
   5. An assisted living community shall annually conduct a comprehensive clinical skills competency review of each medication aide employed by the assisted living community.
   6. Certificates issued pursuant to this subsection shall be renewed biennially according to schedules and fees approved by the department.
   7. A medication aide who meets the criteria established in this subsection shall be permitted to perform the following tasks in an assisted living community in accordance with the written instructions of a physician:
      1. Administer physician ordered oral, ophthalmic, topical, otic, nasal, vaginal, and rectal medications;
      2. Administer insulin, epinephrine, and B12 pursuant to physician direction and protocol;
      3. Administer medication via a metered dose inhaler;
      4. Conduct finger stick blood glucose testing following established protocol;
      5. Administer a commercially prepared disposable enema as ordered by a physician;
      6. Assist residents in the supervision of self-administration of medication; and
      7. Administer liquid morphine to a resident of the assisted living community who is the patient of a licensed hospice, pursuant to a hospice physician's written order that contains specific instructions for indication, dosage, frequency, and route of administration, provided that the licensed hospice consents to the use and administration of liquid morphine as described in this subparagraph. The medication aide shall observe and document the resident's need for all "as needed" (PRN) liquid morphine in such resident's record and such indications of need may include verbalizations of pain, groaning, grimacing, or restlessness. The initial dose of any liquid morphine administered pursuant to this subparagraph shall be administered and assessed by a licensed hospice health care professional to observe and address any adverse reactions to such medication. The assisted living community shall ensure that any medication aides who will be administering liquid morphine to any hospice patients in such assisted living community pursuant to this subparagraph receive adequate training from a licensed hospice on the safe and proper administration of liquid morphine prior to such administration and on an annual basis thereafter. The assisted living community shall maintain documentation of all training provided and shall adhere to all security and storage requirements for liquid morphine required under state and federal law, including but not limited to any rules promulgated by the department. Notwithstanding the foregoing, the supply of liquid morphine on-site at the assisted living community shall be limited to no more than 50 ml for each hospice patient in the assisted living community and shall only be administered under limited circumstances when a licensed hospice health care professional is not otherwise available. The department shall promulgate rules and regulations to implement this subparagraph. The authority provided to a medication aide pursuant to this subparagraph shall be in addition to the authority provided to a medication aide pursuant to subparagraphs (A) through (F) of this paragraph and shall not be construed to limit any authority or practice of a medication aide in effect prior to May 11, 2019.
   8. A medication aide shall record in the medication administration record all medications that such medication aide has personally administered to a resident of an assisted living community and any refusal of a resident to take a medication. A medication aide shall observe a resident to whom medication has been administered and shall report any changes in the condition of such resident to the personal representative or legal surrogate of such resident.
   9. All medication administered by a medication aide in accordance with this Code section shall be in unit or multidose packaging.
   10. An assisted living community that employs one or more medication aides to administer medications in accordance with this subsection shall secure the services of a licensed pharmacist to perform the following duties:
       1. Perform a quarterly review of the drug regimen of each resident of the assisted living community and report any irregularities to the assisted living community administrator;
       2. Remove for proper disposal any drugs that are expired, discontinued, in a deteriorated condition, or when the resident for whom such drugs were ordered is no longer a resident;
       3. Establish or review policies and procedures for safe and effective drug therapy, distribution, use, and control; and
       4. Monitor compliance with established policies and procedures for medication handling and storage.
   11. An assisted living community that employs one or more medication aides to administer medications in accordance with this subsection shall ensure that each medication aide receives ongoing medication training as prescribed by the department. A registered professional nurse or pharmacist shall conduct random medication administration observations on a quarterly basis and report any issues to the assisted living community administrator.
8. An assisted living community shall establish a written care plan for each resident. Such care plan shall describe the needs of the resident and how such needs will be met.
9. An assisted living community shall not be permitted to enroll as a provider of medical assistance, as defined in paragraph (6) of Code Section 49-4-141, or receive any funds authorized or paid pursuant to Title XIX of the Social Security Act.
10. On and after July 1, 2021, all assisted living communities shall be required to meet the following staffing and training requirements:
    1. Ensure that each direct care staff person in the assisted living community receives initial and annual training covering topics specified by the department to ensure a demonstrated knowledge and understanding of caring for elderly and disabled adults; and
    2. Maintain the following minimum staffing requirements:
       1. An average monthly minimum on-site staffing ratio of one direct care staff person for every 15 residents during all waking hours and one direct care staff person for every 20 residents during all nonwaking hours; provided, however, that either such ratio is adequate to meet the needs of the residents;
       2. At least two on-site direct care staff persons at all times; and
       3. A registered professional nurse or licensed practical nurse on-site, as follows:
          1. For assisted living communities with one to 30 residents, a minimum of eight hours per week;
          2. For assisted living communities with 31 to 60 residents, a minimum of 16 hours per week;
          3. For assisted living communities with 61 to 90 residents, a minimum of 24 hours per week; or
          4. For assisted living communities with more than 90 residents, a minimum of 40 hours per week.
11. On and after July 1, 2021, all assisted living communities shall be required to meet the following financial stability requirements:
    1. Upon initial application for an assisted living community license, provide a financial stability affidavit from a certified public accountant affirming the applicant's ability to operate as a going concern for the next two years;
    2. Provide a minimum of 60 days' written notice to the department and all residents of any impending bankruptcy or property eviction that may force discharge or relocation of residents or otherwise adversely impact the provision of safe care and oversight; and
    3. Provide a minimum of 14 days' written notice to the department and all residents of any impending change of ownership that may force discharge or relocation of residents or otherwise adversely impact the provision of safe care and oversight. (Code 1981, § 31-7-12.2 , enacted by Ga. L. 2011, p. 227, § 1/SB 178; Ga. L. 2012, p. 775, § 31/HB 942; Ga. L. 2019, p. 1052, § 1/HB 374; Ga. L. 2020, p. 95, § 6/HB 987.)

U.S. Code. - Title XIX of the Social Security Act, referred to in this Code section, is codified at 42 U.S.C. § 1396 et seq.

The 2019 amendment, effective May 11, 2019, substituted "such" for "the" in the second sentence of paragraph (g)(2) and in the first and second sentences in paragraph (g)(8); substituted "state approved" for "state-approved" in subparagraph (g)(3)(B); deleted "and" at the end of subparagraph (g)(7)(E); added "; and" at the end of subparagraph (g)(7)(F); and added subparagraph (g)(7)(G); inserted "shall" following "administered and" in the middle of the second sentence of paragraph (g)(8); and substituted "when" for "where" in the middle of subparagraph (g)(10)(B).

The 2020 amendment, effective June 30, 2020, in subsection (b), deleted "and" at the end of subparagraph (b)(2)(B); substituted "; and" for a period at the end of subparagraph (b)(2)(C); added subparagraph (b)(2)(D); substituted "office of Safety Fire Commissioner" for "Office of the Safety Fire Commissioner" at the end of paragraph (b)(4); added paragraphs (b)(6) and (b)(7); inserted "or for limited nursing services provided by a registered professional nurse or licensed practical nurse pursuant to subparagraph (b)(2)(D) of this Code section" in the second sentence of subsection (f); and added subsections (j) and (k).

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2011, "31-2-8" was substituted for "31-2-11" at the end of paragraph (c)(7).

Pursuant to Code Section 28-9-5, in 2019, "aide in effect prior to May 11, 2019" was substituted for "aide in effect prior to the effective date of this subparagraph" at the end of the last sentence of subparagraph (g)(7)(G).

31-7-12.3. Adoption of rules and regulations to implement Code Sections 31-7-12 and 31-7-12.2

The department shall adopt rules and regulations to implement Code Sections 31-7-12 and 31-7-12.2. Notwithstanding the provision of limited nursing services by assisted living communities, such rules and regulations shall establish meaningful distinctions between the levels of care provided by personal care homes, assisted living communities, and nursing homes but shall not curtail the scope or levels of services provided by personal care homes or nursing homes as of June 30, 2011; provided, however, that nothing in this chapter shall preclude the department from issuing waivers or variances to personal care homes of the rules and regulations established pursuant to this Code section. Notwithstanding Code Section 31-7-12.2, the department shall not grant a waiver or variance unless:

1. There are adequate standards affording protection for the health and safety of residents of the personal care home;
2. The resident of the personal care home provides a medical assessment conducted by a licensed health care professional who is unaffiliated with the personal care home which identifies the needs of the resident; and
3. The department finds that the personal care home can provide or arrange for the appropriate level of care for the resident. (Code 1981, § 31-7-12.3 , enacted by Ga. L. 2011, p. 227, § 1/SB 178; Ga. L. 2018, p. 611, § 1-2/SB 406; Ga. L. 2020, p. 95, § 7/HB 987.)

The 2018 amendment, effective October 1, 2019, deleted "31-2-9 or" preceding "31-7-12.2" near the end of the introductory paragraph of this Code section.

The 2020 amendment, effective June 30, 2020, substituted "Notwithstanding the provision of limited nursing services by assisted living communities, such rules" for "Such rules" at the beginning of the second sentence of the introductory paragraph.

31-7-12.4. Certificate for operation of memory care center required; staffing and training requirements; other requirements; regulation.

1. As used in this Code section, the term:
   1. "Alzheimer's" means having characteristics of Alzheimer's disease, a progressive and degenerative brain disease that causes impairment or change in memory, thinking, or behavior.
   2. "Assisted living community" means a facility licensed pursuant to Code Section 31-7-12.2.
   3. "Certificate" means a certificate issued by the department pursuant to this Code section to operate a memory care center.
   4. "Dementia" means any disease from a class of degenerative brain disorders that cause impairment or changes in memory, thinking, or behavior that are progressive and irreversible. Such diseases include, but are not limited to, Alzheimer's disease, Lewy body dementia, frontotemporal dementia, and vascular dementia.
   5. "Direct care staff person" means any employee, facility volunteer, or contract staff who provides to residents:
      1. Any personal services, including but not limited to, medication administration or assistance, assistance with ambulation and transfer, and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting; or
      2. Any other limited nursing services, as defined in subsection (b) of Code Section 31-7-12.2.
   6. "Memory care center" means a freestanding or incorporated specialized unit within an assisted living community or personal care home that either:
      1. Holds itself out as providing additional or specialized care to persons with diagnoses of probable Alzheimer's or other dementias or with cognitive deficits that may place the resident at risk; or
      2. Charges higher rates for care for residents with Alzheimer's or other dementias than for care to other residents.
   7. "Personal care home" means a facility licensed pursuant to Code Section 31-7-12.
2. On and after July 1, 2021, no assisted living community or personal care home shall operate a memory care center without first obtaining a certificate from the department. A certificate issued pursuant to this Code section shall not be assignable or transferable. In order to receive a certificate from the department to operate a memory care center, an applicant shall meet and be subject to the requirements contained in this Code section and in rules and regulations established by the department.
3. 1. A memory care center shall meet the following minimum staffing requirements:
      1. One dementia trained direct care staff person for every 12 residents on-site during all waking hours and for every 15 residents on-site during all nonwaking hours based on a monthly average; provided, however, that such ratio is adequate to meet the needs of the residents;
      2. One registered professional nurse, licensed practical nurse, or certified medication aide on-site at all times;
      3. Two direct care staff persons on-site at all times; and
      4. One registered professional nurse or licensed practical nurse on-site or available in the building at all times as follows:
         1. For memory care centers with one to 12 residents, a minimum of eight hours per week;
         2. For memory care centers with 13 to 30 residents, a minimum of 16 hours per week;
         3. For memory care centers with 31 to 40 residents, a minimum of 24 hours per week; or
         4. For memory care centers with more than 40 residents, a minimum of 40 hours per week.
   2. A memory care center shall meet the following training requirements:
      1. All staff, regardless of role, shall receive at least four hours of dementia-specific orientation within the first 30 days of working in the center. Such orientation shall include:
         1. Basic information about the nature, progression, and management of Alzheimer's and other dementias;
         2. Techniques for creating an environment that minimizes challenging behavior from residents with Alzheimer's and other dementias;
         3. Methods of identifying and minimizing safety risks to residents with Alzheimer's and other dementias; and
         4. Techniques for successful communication with individuals with Alzheimer's and other dementias;
      2. All direct care staff personnel shall receive initial orientation training within the first 30 days of caring for residents independently that, at a minimum, includes:
         1. General training, to include:
            1. Development, updating, and implementation of comprehensive and individual service plans;
            2. Skills for recognizing physical or cognitive changes in the resident that warrant seeking medical attention;
            3. Residents' rights and identification of conduct constituting abuse, neglect, or exploitation;
            4. General infection control principles;
            5. Emergency preparedness training;
            6. Emergency first aid; and
            7. Cardiopulmonary resuscitation; and
         2. Specialized training in dementia care, to include:
            1. The nature of Alzheimer's and other dementias;
            2. The center's philosophy related to the care of residents with Alzheimer's and other dementias;
            3. The center's policies and procedures related to care of residents with Alzheimer's and other dementias;
            4. Common behavior problems characteristic of residents with Alzheimer's and other dementias;
            5. Positive therapeutic interventions and activities;
            6. Skills for maintaining the safety of the resident; and
            7. The role of the family in caring for residents with Alzheimer's and other dementias;
      3. Direct care staff personnel shall complete a minimum of 16 hours of specialized training in dementia care within the first 30 days of working independently with residents with Alzheimer's or other dementias, and a minimum of eight hours of such specialized training in dementia care annually thereafter; and
      4. The memory care center shall maintain documentation reflecting course content, instructor qualifications, agenda, and attendance rosters for all training sessions provided.
4. The department shall establish such other requirements as deemed necessary to protect the well-being of residents with Alzheimer's and other dementias, which shall include, but shall not be limited to, requirements relating to:
   1. Admission policies and procedures, assessment of residents, and development of written care plans;
   2. Physical design, environment, and safety measures to accommodate and protect residents; and
   3. Measures and protocols to address and prevent the elopement of residents, including appropriate safety devices and maintaining current photographs of residents.
5. The department shall promulgate rules and regulations to implement the provisions of this Code section.
6. In accordance with subsection (b) of Code Section 31-2-7 , the department upon application or petition may, in its discretion, grant variances and waivers of the rules and regulations applicable to memory care centers. (Code 1981, § 31-7-12.4 , enacted by Ga. L. 2020, p. 95, § 8/HB 987.)

Effective date. - This Code section became effective June 30, 2020.

Cross references. - Alzheimer's and related dementias state plan, § 49-6-90 .

31-7-12.5. Notification and other requirements for COVID-19 infections in personal care homes.

1. As used in this Code section, the term "COVID-19" means coronavirus disease 2019.
2. Each personal care home with 25 or more beds, each assisted living community, and each nursing home licensed in this state shall:
   1. Inform its residents and their representatives or legal surrogates by 5:00 P.M. the next calendar day following the occurrence of either a single confirmed infection of COVID-19 or another airborne infectious disease identified by the department or the federal Centers for Disease Control and Prevention as a threat to public health, or three or more residents or staff with new-onset of respiratory symptoms occurring within 72 hours of each other. Such information shall:
      1. Not include personally identifiable information;
      2. Include information on mitigating actions implemented to prevent or reduce the risk of transmission, including if normal operations of the facility will be altered; and
      3. Include any cumulative updates for residents and their representatives or legal surrogates at least weekly or by 5:00 P.M. the next calendar day following the occurrence of any subsequent confirmed infection of COVID-19, or whenever three or more residents or staff with new onset of respiratory symptoms occurs within 72 hours of each other;
   2. Maintain a minimum of a seven-day supply of protective masks, surgical gowns, eye protection, and gloves sufficient to protect all residents and staff;
   3. Maintain and publish for its residents and their representatives or legal surrogates policies and procedures pertaining to infection control and mitigation within their facilities and update such policies and procedures annually; and
   4. As part of the facility's disaster preparedness plan required pursuant to subsection (c) of Code Section 31-7-3 and department rules and regulations, include an epidemic and pandemic plan for influenza and other infectious diseases which conforms to department and federal Centers for Disease Control and Prevention standards that contains the following minimum elements:
      1. Protocols for surveillance and detection of epidemic and pandemic diseases in residents and staff;
      2. A communication plan for sharing information with public health authorities, residents, residents' representatives or their legal surrogates, and staff;
      3. An education and training plan for residents and staff regarding infection control protocols;
      4. An infection control plan that addresses visitation, cohorting measures, sick leave and return-to-work policies, and testing and immunization policies; and
      5. A surge capacity plan that addresses protocols for contingency staffing and supply shortages. (Code 1981, § 31-7-12.5 , enacted by Ga. L. 2020, p. 95, § 8/HB 987.)

Effective date. - This Code section became effective June 30, 2020.

31-7-12.6. SARS CoV-2 testing for residents and staff in long-term care facilities.

1. As used in this Code section, the term:
   1. "Direct care staff person" means any employee, facility volunteer, or contract staff who provides to residents:
      1. Any personal services, including but not limited to, medication administration or assistance, assistance with ambulation and transfer, and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting; or
      2. Any other limited nursing services, as defined in subsection (b) of Code Section 31-7-12.2.
   2. "Long-term care facility" means a personal care home with 25 or more beds, an assisted living community, or a nursing home licensed in this state.
2. No later than September 28, 2020, each resident and direct care staff person in a long-term care facility in this state shall be required to receive an initial baseline molecular SARS CoV-2 test as outlined by the federal Centers for Disease Control and Prevention; provided, however, that residents and direct care staff persons tested prior to June 30, 2020, shall not be required to receive such test.
3. The department shall be authorized to establish rules and regulations to require testing of new residents and direct care staff persons on and after September 28, 2020. (Code 1981, § 31-7-12.6 , enacted by Ga. L. 2020, p. 95, § 8/HB 987.)

Effective date. - This Code section became effective June 30, 2020.

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2020, in subsection (b), substituted "September 28, 2020," for "90 days after the effective date of this Act" at the beginning and substituted "June 30, 2020," for "the effective date of this Act" near the end; and substituted "September 28, 2020" for "90 days after the effective date of this Act" at the end of subsection (c).

31-7-13. Transfer of property upon death of patient.

1. Whenever any person dies in a hospital licensed pursuant to this chapter, in any federal hospital operating within this state, or any nursing home operated within this state, such hospital or nursing home shall be authorized but shall not be required to transfer possession of any property, tangible or intangible, of such patient which is in the possession of the hospital or nursing home, to the following persons:
   1. To the person designated by the patient in writing upon admission to the hospital or nursing home, if any;
   2. To the surviving spouse of the patient, if any;
   3. If no surviving spouse, to any adult child of the patient, and if no such adult child, to any person acting in loco parentis of any minor child;
   4. If no surviving spouse or surviving children, to either parent of the patient;
   5. If none of the above, then to any brother or sister of the patient; or
   6. If none of the above, to the person assuming responsibility for burial of the patient.
2. The transfer of possession to the surviving spouse or any of the other family members or persons listed in subsection (a) of this Code section shall operate as a complete acquittal and discharge to the hospital or nursing home of liability from any suit, claim, or demand of whatever nature by any heir, distributee, or creditor of the patient, or any other person as relates to the property transferred. Such distribution is authorized to be made as provided in this Code section without the necessity of administration of the estate of the patient and without the necessity of obtaining an order that no administration of such estate is necessary.
3. The transfer of possession provided for in this Code section shall in no way affect the legal ownership or title to any property so transferred.
4. The provisions of any law of descent or distribution or any will or other instrument providing for disposition of property shall not be impaired by this Code section, and any person to whom property is transferred pursuant to this Code section may be required to transfer that property in conformity with the disposition of property required by such laws of descent or distribution or such will or other instrument. (Code 1981, § 31-7-11 , enacted by Ga. L. 1984, p. 778, § 1; Ga. L. 2009, p. 8, § 31/SB 46.)

Code Commission notes. - Code Section 31-7-11 was added to the Code by both Ga. L. 1983, p. 1307, § 1, and Ga. L. 1984, p. 778, § 1. The former is set out as Code Section 31-7-11 and the latter is set out above as Code Section 31-7-13 pursuant to the authority granted by Code Section 28-9-5.

31-7-14. Blood supplies; blood donor storage programs.

1. When any person is admitted to a medical facility for surgical or medical treatment which has been scheduled in advance, neither the medical facility nor any licensed medical practitioner shall prohibit such person from providing a blood donor or donors to furnish blood which may be needed in such surgery or medical treatment, provided that:
   1. The blood donation will not be detrimental to the donor or the recipient of such blood or any of its components; and
   2. The donation is made not earlier than ten working days before the date of the anticipated transfusion and not later than the evening of the fourth full working day before the date of the anticipated transfusion.
2. If the person receiving surgical or other medical treatment requires more blood than is furnished by the provided donor or donors, then the medical facility may utilize its regular sources to supply the necessary amount. If less blood than the amount that is furnished by the provided donor or donors is used in the surgery or medical treatment, then the excess blood may be retained by the medical facility or turned over to a community blood bank.
3. This Code section shall not apply to any emergency surgical or medical treatment.
4. This Code section shall not apply to any medical facility which does not maintain a system for the collection, processing, and storage of blood and its component parts or to any medical facility which allows through a community blood bank a person to provide a blood donor or donors to furnish blood which may be needed in the person's surgery or medical treatment.
5. This Code section shall not apply to any person who is under the jurisdiction of the Department of Corrections.
6. A medical facility or licensed medical practitioner providing health care to a person who utilizes the provisions of this Code section shall not be liable in damages for injury or death occurring during or as a result of the medical or surgical treatment if the injury or death results from use of the blood supplied by the donors selected by the patient, unless that facility or practitioner is grossly negligent with regard to such use.
7. A medical facility or group of medical facilities may organize and operate short-term blood donor storage programs for the purpose of perpetuating a group of donors of a common blood type for emergency and planned surgical needs. (Code 1981, § 31-7-14 , enacted by Ga. L. 1987, p. 1091, § 1.)

Code Commission notes. - Ga. L. 1987, p. 1091, § 1 and Ga. L. 1987, p. 1494, § 1 enacted different Code sections designated Code Section 31-7-14. Pursuant to Code Section 28-9-5, the Code section enacted by Ga. 1987, p. 1494, § 1 was redesignated as Code Section 31-7-15.

31-7-15. Review of professional practices by a peer review committee.

1. A hospital or ambulatory surgical center shall provide for the review of professional practices in the hospital or ambulatory surgical center for the purpose of reducing morbidity and mortality and for the improvement of the care of patients in the hospital or ambulatory surgical center. This review shall include, but shall not be limited to, the following:
   1. The quality of the care provided to patients as rendered in the hospital or ambulatory surgical center;
   2. The review of medical treatment and diagnostic and surgical procedures in order to foster safe and adequate treatment of patients in the hospital or ambulatory surgical center; and
   3. The evaluation of medical and health care services or the qualifications and professional competence of persons performing or seeking to perform such services.
2. The functions required by subsection (a) of this Code section may be performed by a "peer review committee," defined as a committee of physicians appointed by a state or local or specialty medical society or appointed by the governing board or medical staff of a licensed hospital or ambulatory surgical center or any other organization formed pursuant to state or federal law and engaged by the hospital or ambulatory surgical center for the purpose of performing such functions required by subsection (a) of this Code section.
3. Compliance with the above provisions of subsection (a) of this Code section shall constitute a requirement for granting or renewing the permit of a hospital or ambulatory surgical center. The functions required by this Code section shall be carried out under the regulations and supervision of the department.
4. Proceedings and records conducted or generated in an attempt to comply with the duties imposed by subsection (a) of this Code section shall not be subject to the provisions of either Chapter 14 or Article 4 of Chapter 18 of Title 50.
5. Nothing in this or any other Code section shall be deemed to require any hospital or ambulatory surgical center to grant medical staff membership or privileges to any licensed practitioner of the healing arts. (Code 1981, § 31-7-15 , enacted by Ga. L. 1987, p. 1494, § 1.)

Code Commission notes. - Ga. L. 1987, p. 1091, § 1 and Ga. L. 1987, p. 1494, § 1 enacted different Code sections designated Code Section 31-7-14. Pursuant to Code Section 28-9-5, the Code section enacted by Ga. 1987, p. 1494, § 1 was redesignated as Code Section 31-7-15.

31-7-16. Determination or pronouncement of death of patient who died in facility classified as nursing home.

When a patient dies in any facility classified as a nursing home by the department and operating under a permit issued by the department, a physician assistant, a nurse practitioner, or a registered professional nurse licensed in this state and employed by such nursing home at the time of apparent death of such person, in the absence of a physician, may make the determination and pronouncement of the death of said patient; provided, however, that when it appears that a patient died from other than natural causes, only a physician may make the determination or pronouncement of death. Such determination or pronouncement shall be made in writing on a form approved by the department.

(Code 1981, § 31-7-16 , enacted by Ga. L. 1996, p. 1243, § 1; Ga. L. 2009, p. 859, § 3/HB 509; Ga. L. 2017, p. 625, § 1/SB 96.)

The 2017 amendment, effective July 1, 2017, in the first sentence, inserted ", a nurse practitioner," near the beginning and deleted "that, when said patient is a registered organ donor, only a physician may make the determination or pronouncement of death; provided, further," preceding "that when it" near the end.

31-7-17. Licensure and regulation of hospitals and related institutions transferred to Department of Community Health.

1. Effective July 1, 2009, all matters relating to the licensure and regulation of hospitals and related institutions pursuant to this article shall be transferred from the Department of Human Resources (now known as the Department of Human Services) to the Department of Community Health.
2. The Department of Community Health shall succeed to all rules, regulations, policies, procedures, and administrative orders of the Department of Human Resources that are in effect on June 30, 2009, or scheduled to go into effect on or after July 1, 2009, and which relate to the functions transferred to the Department of Community Health pursuant to this Code section and shall further succeed to any rights, privileges, entitlements, obligations, and duties of the Department of Human Resources that are in effect on June 30, 2009, which relate to the functions transferred to the Department of Community Health pursuant to this Code section. Such rules, regulations, policies, procedures, and administrative orders shall remain in effect until amended, repealed, superseded, or nullified by the Department of Community Health by proper authority or as otherwise provided by law.
3. The rights, privileges, entitlements, and duties of parties to contracts, leases, agreements, and other transactions entered into before July 1, 2009, by the Department of Human Resources which relate to the functions transferred to the Department of Community Health pursuant to this Code section shall continue to exist; and none of these rights, privileges, entitlements, and duties are impaired or diminished by reason of the transfer of the functions to the Department of Community Health. In all such instances, the Department of Community Health shall be substituted for the Department of Human Resources, and the Department of Community Health shall succeed to the rights and duties under such contracts, leases, agreements, and other transactions.
4. All persons employed by the Department of Human Resources in capacities which relate to the functions transferred to the Department of Community Health pursuant to this Code section on June 30, 2009, shall, on July 1, 2009, become employees of the Department of Community Health in similar capacities, as determined by the commissioner of community health. Such employees shall be subject to the employment practices and policies of the Department of Community Health on and after July 1, 2009, but the compensation and benefits of such transferred employees shall not be reduced as a result of such transfer. Employees who are subject to the rules of the State Personnel Board and who are transferred to the department shall retain all existing rights under such rules. Retirement rights of such transferred employees existing under the Employees' Retirement System of Georgia or other public retirement systems on June 30, 2009, shall not be impaired or interrupted by the transfer of such employees and membership in any such retirement system shall continue in the same status possessed by the transferred employees on June 30, 2009. Accrued annual and sick leave possessed by said employees on June 30, 2009, shall be retained by said employees as employees of the Department of Community Health. (Code 1981, § 31-7-17 , enacted by Ga. L. 2008, p. 12, § 2-14/SB 433; Ga. L. 2009, p. 453, § 1-28/HB 228; Ga. L. 2009, p. 745, § 2/SB 97; Ga. L. 2012, p. 446, § 2-37/HB 642.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2008, Code Section 31-7-17, as enacted by Ga. L. 2008, p. 520, § 1, was redesignated as Code Section 31-7-18.

Editor's notes. - Ga. L. 2012, p. 446, § 3-1/HB 642, not codified by the General Assembly, provides that: "Personnel, equipment, and facilities that were assigned to the State Personnel Administration as of June 30, 2012, shall be transferred to the Department of Administrative Services on the effective date of this Act." This Act became effective July 1, 2012.

Ga. L. 2012, p. 446, § 3-2/HB 642, not codified by the General Assembly, provides that: "Appropriations for functions which are transferred by this Act may be transferred as provided in Code Section 45-12-90."

31-7-18. Influenza vaccinations for discharged patients aged 65 and older; vaccinations or other measures for health care workers and other employees in hospitals; immunity from liability; standing orders.

1. Prior to discharging any inpatient who is 65 years of age or older, a hospital shall offer the inpatient vaccinations for the influenza virus and pneumococcal disease in accordance with the recommendations of the Centers for Disease Control and Prevention and any applicable rules and regulations of the department, unless contraindicated and contingent on availability of such vaccine. A hospital may offer other patients such vaccinations in accordance with the recommendations of the Centers for Disease Control and Prevention and any applicable rules and regulations of the department. The vaccinations may be administered pursuant to a standing order that has been approved by the hospital's medical staff.
2. A hospital shall annually offer to its health care workers and other employees who have direct contact with patients, at no cost, vaccinations for the influenza virus in accordance with the recommendations of the Centers for Disease Control and Prevention, subject to availability of the vaccine. A hospital may offer to its health care workers and other employees any other vaccination, test, or prophylactic measure required or recommended by, and in accordance with the recommendations of, the Centers for Disease Control and Prevention. All such vaccinations, tests, or prophylactic measures may be offered or administered pursuant to standing orders approved by the hospital's medical staff to ensure the safety of employees, patients, visitors, and contractors.
3. A hospital or health care provider acting in good faith and in accordance with generally accepted health care standards applicable to such hospital or health care provider shall not be subject to administrative, civil, or criminal liability or to discipline for unprofessional conduct for complying with the requirements of this Code section.
4. Nothing in this Code section shall restrict or limit the use of standing orders in hospitals for any other lawful purpose. (Code 1981, § 31-7-18 , enacted by Ga. L. 2008, p. 520, § 1/HB 1105; Ga. L. 2009, p. 184, § 2/HB 217; Ga. L. 2010, p. 529, § 1/HB 1179.)

Cross references. - Influenza vaccine protocol agreements, § 43-34-26.1 .

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2008, Code Section 31-7-17, as enacted by Ga. L. 2008, p. 520, § 1, was redesignated as Code Section 31-7-18.

31-7-19. Nursing homes to annually offer influenza vaccinations to health care workers and other employees; immunity from liability.

1. Each nursing home shall annually offer on site to its health care workers and other employees who have direct contact with patients, at no cost, vaccinations for the influenza virus in accordance with the recommendations of the Centers for Disease Control and Prevention, subject to availability of the vaccine. Each nursing home shall keep on record a signed statement from each such health care worker and employee stating that he or she has been offered vaccination against the influenza virus and has either accepted or declined such vaccination. A nursing home may offer to its health care workers and other employees who have direct contact with patients any other vaccination required or recommended by, and in accordance with the recommendations of, the Centers for Disease Control and Prevention, which may be offered or administered pursuant to standing orders approved by the nursing home's medical staff to ensure the safety of employees, patients, visitors, and contractors.
2. A nursing home or health care provider acting in good faith and in accordance with generally accepted health care standards applicable to such nursing home or health care provider shall not be subject to administrative, civil, or criminal liability or to discipline for unprofessional conduct for complying with the requirements of this Code section. (Code 1981, § 31-7-19 , enacted by Ga. L. 2013, p. 783, § 1/HB 208.)

31-7-20. Medical facilities to make good faith application to southern regional TRICARE managed care support coordinator for certification in the TRICARE program.

1. Each medical facility in this state shall, not later than July 1, 2015, make a good faith application to the southern regional TRICARE managed care support contractor for certification in the TRICARE program.
2. If any medical facility fails to qualify for certification in the TRICARE program, such medical facility shall implement a plan to upgrade the facility, equipment, personnel, or such other cause for the disqualification within one year of notice of such deficiency.
3. Each medical facility shall submit reports to the commissioner detailing its efforts to join the TRICARE program and shall submit copies of applications, acceptances or rejections, correspondences, and any other information the commissioner deems necessary.
4. The commissioner shall maintain files on each medical facility in this state and shall monitor each medical facility's efforts to join the TRICARE program.
5. Nothing in this Code section shall require a medical facility to enter into a contract with the southern regional managed care support contractor or to participate in TRICARE as a network provider or as a participating non-network provider, as such terms are defined in the federal TRICARE regulations. (Code 1981, § 31-7-20 , enacted by Ga. L. 2014, p. 83, § 1-1/SB 391.)

Editor's notes. - Ga. L. 2008, p. 224, § 2/SB 130, effective July 1, 2008, repealed this Code section. Former Code Section 31-7-20 was part of former Article 2 of this chapter, relating to the Georgia Building Authority (Hospital), and was based on Ga. L. 1939, p. 144, § 1; Ga. L. 1967, p. 860, § 1; Ga. L. 1996, p. 6, § 31.

31-7-21. Provision of influenza education information to assisted living community residents.

1. Each assisted living community shall annually provide to each of its residents, no later than September 1 of each year, educational information on influenza disease. Such information shall include, but is not limited to, the risks associated with influenza disease; the availability, effectiveness, and known contraindications of the influenza immunization; causes and symptoms of influenza; and the means in which it is spread. Provision of the appropriate and current Vaccine Information Statement as provided by the Centers for Disease Control and Prevention shall be deemed to comply with this subsection.
2. Nothing in this Code section shall be construed to require an assisted living community to provide or pay for any vaccination against influenza for its residents.
3. No person shall have a cause of action for any loss or damage caused by any act or omission resulting from providing, or the lack of providing, educational information pursuant to this Code section. (Code 1981, § 31-7-21 , enacted by Ga. L. 2016, p. 544, § 1/HB 902.)

Editor's notes. - Ga. L. 2008, p. 224, § 2/SB 130, effective July 1, 2008, repealed this Code section. Former Code Section 31-7-21 was part of former Article 2 of this chapter, relating to the Georgia Building Authority (Hospital), and was based on Ga. L. 1939, p. 144, § 3; Ga. L. 1964, p. 95, § 1; Ga. L. 1967, p. 860, § 2.

31-7-22. Required publication by hospital of certain documentation on website; updating; penalty for noncompliance; enforcement; individual criminal penalty.

1. As used in this Code section, the term "hospital" means a nonprofit hospital, a hospital owned or operated by a hospital authority, or a nonprofit corporation formed, created, or operated by or on behalf of a hospital authority.
2. Beginning October 1, 2019, each hospital in this state shall post a link in a prominent location on the main page of its website to the most recent version of the following documents:
   1. Federal related disclosures:
      1. Copies of audited financial statements that are general purpose financial statements, which express the unqualified opinion of an independent certified public accounting firm for the most recently completed fiscal year for the hospital; each of its affiliates, except those affiliates that were inactive or that had an immaterial amount of total assets; and the hospital's parent corporation that include the following:
         1. A PDF version of all audited financial statements;
         2. A note in the hospital's audited financial statements that identifies individual amounts for such hospital's gross patient revenue, allowances, charity care, and net patient revenue;
         3. Audited consolidated financial statements for hospitals with subsidiaries and consolidating financial statements that at a minimum contain a balance sheet and statement of operations and that provide a breakout of the hospital's and each subsidiary's numbers with a report from independent accountants on other financial information; and
         4. Audited consolidated financial statements for the hospital's parent corporation and consolidating financial statements that at a minimum contain a balance sheet and statement of operations and that provide a breakout of the hospital's and each affiliate's numbers with a report from independent accountants on other financial information; and
      2. Copy of audited Internal Revenue Service Form 990, including Schedule H for hospitals and other applicable attachments; provided, however, that for any hospital not required to file IRS Form 990, the department shall establish and provide a form that collects the same information as is contained in Internal Revenue Service Form 990, including Schedule H for hospitals, as applicable; and
   2. Georgia supplemental disclosures:
      1. Copy of the hospital's completed annual hospital questionnaire, as required by the department;
      2. The community benefit report prepared pursuant to Code Section 31-7-90.1, if applicable;
      3. The disproportionate share hospital survey, if applicable;
      4. Listing of all real property holdings of the hospital, including the location and size, parcel ID number, purchase price, current use, and any improvements made to such property;
      5. Listing of any ownership or interest the nonprofit hospital has in any joint venture, partnership, subsidiary holding company, or captive insurance company; where any such entity is domiciled; and the value of any such ownership or interest;
      6. Listing of any bonded indebtedness, outstanding loans, and bond defaults, whether or not in forbearance; and any bond disclosure sites of the hospital;
      7. A report that identifies by purpose, the ending fund balances of the net assets of the hospital and each affiliate as of the close of the most recently completed fiscal year, distinguishing between donor permanently restricted, donor temporarily restricted, board restricted and unrestricted fund balances. The hospital's interest in its foundation shall be deducted from the foundation's total fund balance;
      8. Copy of all going concern statements regarding the hospital;
      9. The most recent legal chart of corporate structure, including the hospital, each of its affiliates and subsidiaries, and its parent corporation, duly dated;
      10. Report listing the salaries and fringe benefits for the ten highest paid administrative positions in the hospital. Each position shall be identified by its complete, unabbreviated title. Fringe benefits shall include all forms of compensation, whether actual or deferred, made to or on behalf of the employee, whether full or part-time;
      11. Evidence of accreditation by accrediting bodies, including, but not limited to, the Joint Commission and DNV; and
      12. Copy of the hospital's policies regarding the provision of charity care and reduced cost services to the indigent, excluding medical assistance recipients, and its debt collection practices.
3. Each hospital shall update the documents in the links posted pursuant to subsection (b) of this Code section on July 1 of each year or more frequently at its discretion. Noncurrent documents shall remain posted and accessible on the hospital's website indefinitely.
4. All documents listed in subsection (b) of this Code section shall be prepared in accordance with generally accepted accounting principles, as applicable.
5. The department shall also post a link in a prominent location on its website to the documents listed in subsection (b) of this Code section for each hospital in this state.
6. Any hospital that fails to post the documents required pursuant to subsection (b) of this Code section within 30 days of the dates required in this Code section shall be suspended from receiving any state funds or any donations pursuant to Code Section 48-7-29.20; provided, however, that the department shall provide a hospital notice of any deficiency and opportunity to correct such deficiency prior to any suspension of funds pursuant to this subsection.
7. The department shall have jurisdiction to enforce this Code section and to promulgate rules and regulations required to administer this Code section.
8. Any person who knowingly and willfully includes false, fictitious, or fraudulent information in any documents required to be posted pursuant to this Code section shall be subject to a violation of Code Section 16-10-20 . (Code 1981, § 31-7-22 , enacted by Ga. L. 2019, p. 183, § 1/HB 321.)

Effective date. - This Code section became effective April 25, 2019.

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2019, the enactment of this Code section by Ga. L. 2019, p. 148, § 1-13/HB 186, irreconcilably conflicted with and was treated as superseded by Ga. L. 2019, p. 183, § 1/HB 321.

Editor's notes. - Ga. L. 2008, p. 224, § 2, effective July 1, 2008, repealed this Code section. Former Code Section 31-7-22 was part of former Article 2 of this chapter, relating to the Georgia Building Authority (Hospital), and was based on Ga. L. 1939, p. 144, § 2; Ga. L. 1941, p. 250, § 1; Ga. L. 1967, p. 862, § 1; Ga. L. 1972, p. 1015, § 417; Ga. L. 1985, p. 149, § 31; Ga. L. 1988, p. 426, § 1.

31-7-23 through 31-7-40.

Reserved. Repealed by Ga. L. 2008, p. 224, § 2/SB 130, effective July 1, 2008.

Editor's notes. - This article consisted of former Code Sections 31-7-20 through 31-7-40, relating to the Georgia Building Authority (Hospital), and was based on Ga. L. 1939, p. 144, §§ 1-17, 19; Ga. L. 1941, p. 250, §§ 1, 4; Ga. L. 1946, p. 56, § 1; Ga. L. 1951, p. 22, § 1; Ga. L. 1953, p. 357, § 1; Ga. L. 1960, p. 48, § 1; Ga. L. 1964, p. 95, §§ 1-3; Ga. L. 1964, p. 666, § 1; Ga. L. 1966, p. 302, § 1; Ga. L. 1967, p. 852, § 1; Ga. L. 1967, p. 860, §§ 1-4; Ga. L. 1967, p. 862, § 1; Ga. L. 1970, p. 159, § 1; Ga. L. 1972, p. 1015, § 417; Ga. L. 1983, p. 3, § 55; Ga. L. 1985, p. 149, § 31; Ga. L. 1988, p. 426, § 1; Ga. L. 1991, p. 94, § 31; Ga. L. 1993, p. 1402, § 18; Ga. L. 1996, p. 6, § 31; Ga. L. 2001, p. 4, § 31.

31-7-50. Authorization of grants-in-aid.

The state is authorized to make grants to any county, municipality, or any combination thereof or to any hospital authority to assist in the construction and modernization of publicly owned and publicly operated medical facilities, auxiliary medical facilities, and mental health centers as defined in Code Section 31-7-51. The amount of the grant shall be determined in accordance with Code Sections 31-7-52 and 31-7-53.

(Ga. L. 1949, p. 263, § 1; Ga. L. 1953, Jan.-Feb. Sess., p. 214, § 1; Ga. L. 1955, p. 410, § 1; Code 1933, § 88-2101, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1966, p. 716, § 1; Ga. L. 2015, p. 385, § 4-2/HB 252.)

Editor's notes. - Ga. L. 2015, p. 385, § 1-1/HB 252, not codified by the General Assembly, provides that: "This Act shall be known and may be cited as the 'J. Calvin Hill, Jr., Act.' "

31-7-51. Definitions.

1. As used in this article, the term:
   1. "Auxiliary medical facilities" means diagnostic and treatment facilities, nursing homes, chronic illness hospitals, and rehabilitation centers.
   2. "Construction project" means a program for the construction of any medical facility or auxiliary medical facility or mental health center, as evidenced by the approval of a project under Title VI or Title VII of the federal Public Health Service Act, as now or hereafter amended.
   3. "Hospital authority" means any hospital authority created under the "Hospital Authorities Law," Article 4 of this chapter, as now or hereafter amended.
   4. "Medical facilities" means general hospitals, psychiatric hospitals, nurse training facilities, tuberculosis hospitals, and public health centers.
   5. "Mental health center" means a facility providing services for the prevention or diagnosis of mental illness, or care and treatment of mentally ill patients, or rehabilitation of such persons, which services are provided principally for persons residing in a particular community or communities in or near which the facility is situated.
   6. Reserved.
   7. "Modernization project" means the alteration, major repair, remodeling, replacement, and renovation of existing buildings (including original equipment thereof) and replacement of obsolete, built-in equipment of existing buildings, as evidenced by the approval of a project under Title VI or Title VII of the federal Public Health Service Act, as now or hereafter amended.
   8. "Publicly operated" means operated by a county, municipality, hospital authority, or any combination thereof.
   9. "Publicly owned" means that a county, municipality, hospital authority, or any combination thereof holds title to or has a long-term lease acceptable to the state agency on the property on which the construction or modernization is proposed.
   10. "State agency" means the State Health Planning and Development Agency or any successor designated as the agency of state government to administer the state construction and modernization plan and receive funds pursuant to Titles VI and VII of the federal Public Health Service Act, as amended.
2. The terms "hospital," "psychiatric hospital," "nurse training facilities," "public health center," "rehabilitation facility," "nursing home," "chronic illness hospital," "long-term care facility," "mental health center," "construction," "cost of construction," "modernization," and "cost of modernization" shall have meanings consistent with those respectively ascribed to them in Titles VI and VII of the federal Public Health Service Act, as now or hereafter amended.

   (Code 1933, § 88-2102, enacted by Ga. L. 1966, p. 716, § 1; Ga. L. 1996, p. 6, § 31; Ga. L. 2015, p. 385, § 4-3/HB 252.)

Editor's notes. - Ga. L. 2015, p. 385, § 1-1/HB 252, not codified by the General Assembly, provides that: "This Act shall be known and may be cited as the 'J. Calvin Hill, Jr., Act.' "

U.S. Code. - Titles VI and VII of the Public Health Service Act, as amended, referred to in this Code section, are codified as 42 U.S.C. § 291 et seq. and 42 U.S.C. § 292a et seq., respectively.

31-7-52. Amounts of grants for construction and modernization.

1. Grants for construction projects or modernization projects made from state appropriations pursuant to this article shall be in an amount equal to one-third of the allowable cost of the project, except as otherwise provided in this article.
2. In the event that state funds appropriated or otherwise made available during a given fiscal year for construction or modernization are not sufficient to match available federal funds, the state agency shall be empowered to:
   1. Reduce the percentage of contribution by the state below one-third of the allowable cost of the project in order to obtain the optimum amount of construction with funds available; and
   2. At its option, annually establish a ceiling which shall be the maximum amount that can be allotted to each or any medical facility project approved in the given fiscal year, provided that any ceiling so established shall not result in the allotment to a medical facility project of an amount greater than the one-third of allowable cost specified in subsection (a) of this Code section.
3. The aggregate of federal and state funds granted to publicly owned and publicly operated construction or modernization projects shall be 66 2/3 percent unless state funds are inadequate to obtain optimum construction, in which event the state agency is authorized to establish an aggregate less than 66 2/3 percent.
4. In the event an aggregate of federal and state funds is established at less than 66 2/3 percent, the state agency is authorized to establish a matching formula for any category of construction which is different from any other matching formula for any other category of construction; the state agency is further authorized to establish a matching formula for any category of modernization which is different from the matching formula for construction projects.

   (Ga. L. 1949, p. 263, § 1; Ga. L. 1953, Jan.-Feb. Sess., p. 214, § 1; Ga. L. 1955, p. 410, § 1; Code 1933, § 88-2103, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1966, p. 716, § 1; Ga. L. 1969, p. 715, §§ 4, 5.)

31-7-53. Matching formula; priority system; use of earnings; approval of federal grant.

1. The state agency shall establish a matching formula for each construction and modernization category by fiscal year. Any change in a matching formula shall apply in the same manner to each construction and modernization project within the category approved during the fiscal year.
2. Grants made pursuant to this article shall be in accordance with the priority system as approved by the state agency and the United States secretary of health and human services.
3. No part of the net earnings of publicly owned and publicly operated medical facilities, auxiliary medical facilities, and mental health centers constructed with the assistance of a grant under this article shall inure to the benefit of any private corporation or individual.
4. Any grant made pursuant to this article shall be contingent upon the approval for that project of a federal grant approved by the United States secretary of health and human services under either Title VI or Title VII of the federal Public Health Service Act, as now or hereafter amended.

   (Ga. L. 1949, p. 263, § 1; Ga. L. 1953, Jan.-Feb. Sess., p. 214, § 1; Ga. L. 1955, p. 410, § 1; Code 1933, § 88-2105, enacted by Ga. L. 1964, p. 499, § 1; Code 1933, § 88-2104, enacted by Ga. L. 1966, p. 716, § 1; Ga. L. 1982, p. 3, § 31; Ga. L. 1992, p. 6, § 31; Ga. L. 2015, p. 385, § 4-4/HB 252; Ga. L. 2017, p. 774, § 31/HB 323.)

The 2017 amendment, effective May 9, 2017, part of an Act to revise, modernize, and correct the Code, substituted "the federal Public Health Service Act" for "the Public Health Service Act" near the end of subsection (d).

Editor's notes. - Ga. L. 2015, p. 385, § 1-1/HB 252, not codified by the General Assembly, provides that: "This Act shall be known and may be cited as the 'J. Calvin Hill, Jr., Act.' "

U.S. Code. - Titles VI and VII of the Public Health Service Act, as amended, referred to in subsection (d), are codified as 42 U.S.C. § 291 et seq. and 42 U.S.C. § 292a et seq., respectively.

31-7-54. Manner of expenditure of construction funds.

In order to assist the several counties, municipalities, or any combination thereof or any hospital authorities created under the "Hospital Authorities Law," Article 4 of this chapter, such funds as are appropriated for each fiscal year for the construction of publicly owned and publicly operated medical facilities, auxiliary medical facilities, and mental health centers shall be expended in accordance with the provisions of this article.

(Ga. L. 1949, p. 263, § 2; Ga. L. 1955, p. 410, § 2; Code 1933, § 88-2106, enacted by Ga. L. 1964, p. 499, § 1; Code 1933, § 88-2105, enacted by Ga. L. 1966, p. 716, § 1; Ga. L. 2015, p. 385, § 4-5/HB 252.)

Editor's notes. - Ga. L. 2015, p. 385, § 1-1/HB 252, not codified by the General Assembly, provides that: "This Act shall be known and may be cited as the 'J. Calvin Hill, Jr., Act.' "

31-7-55. Administration of state funds.

The state agency is to be the sole agency for the administration of state funds pursuant to this article. The administration of such funds shall be in direct conjunction with that of federal funds under Titles VI and VII of the Public Health Service Act, as now or hereafter amended.

(Ga. L. 1949, p. 263, § 3; Ga. L. 1955, p. 410, § 3; Code 1933, § 88-2107, enacted by Ga. L. 1964, p. 499, § 1; Code 1933, § 88-2106, enacted by Ga. L. 1966, p. 716, § 1.)

U.S. Code. - Titles VI and VII of the Public Health Service Act, as amended, referred to in this Code section, are codified as 42 U.S.C. § 291 et seq. and 42 U.S.C. § 292a et seq., respectively.

31-7-56. Adherence to federal law and regulations.

The establishment of hospital service areas, the determination of relative need, the priority of projects, and the standards of construction shall be consistent with Titles VI and VII of the Public Health Service Act, as now or hereafter amended, and the federal regulations prescribed thereunder.

(Ga. L. 1949, p. 263, § 5; Ga. L. 1955, p. 410, § 5; Code 1933, § 88-2108, enacted by Ga. L. 1964, p. 499, § 1; Code 1933, § 88-2107, enacted by Ga. L. 1966, p. 716, § 1.)

U.S. Code. - Titles VI and VII of the Public Health Service Act, as amended, referred to in this Code section, are codified as 42 U.S.C. § 291 et seq. and 42 U.S.C. § 292a et seq., respectively.

31-7-57. Procedure for grants to sponsors of construction projects; injunction of operation by transferee in violation of article.

1. For each construction project, there shall be submitted to the state agency an application for state funds.
2. Upon approving an application under this Code section, the state agency shall submit a budget request to the Office of Planning and Budget, based upon such application. Approval by the Office of Planning and Budget shall constitute an obligation of the state.
3. Payments to the sponsor of a construction project shall be made in installments as construction progresses at intervals to be determined at the discretion of the state agency; and the state agency shall have the right to inspect and audit records and accounts of the sponsor as a condition precedent to making payments.
4. If any publicly owned and publicly operated medical facility, auxiliary medical facility, or mental health center for which funds have been paid under this Code section shall be leased to any corporation, person, organization, or body other than one eligible to receive a grant under this article or shall be sold or used for any purpose contrary to the provision under which the grant was made, at any time within 20 years after completion of construction, and such change in lease, sale, or use is not approved by the state agency, such agency may bring an equitable proceeding for writ of injunction against any person, firm, corporation, or organization operating in violation of this article. The proceedings shall be filed in the county in which such persons reside or, in the case of a firm or corporation, where such firm or corporation maintains its principal office; and, unless it is shown that such person, firm, or corporation which has leased such medical facility, auxiliary medical facility, or mental health center would have been eligible to accept the grant-in-aid from the state in the first instance and the lease has been approved by the state agency or the sale or use has been approved by such agency, the writ of injunction shall issue and such person, firm, or corporation shall be perpetually enjoined throughout the state from operating in violation of the provisions of this subsection. It shall not be necessary in order to obtain the equitable relief provided in this subsection that the state agency show that such person, firm, or corporation is ineligible nor to prove that there is no adequate remedy at law. In addition, the state agency shall be entitled to bring an action and recover from the transferor and transferee of any facility specified in this subsection such percentage of the value of the facility as the state grant bore toward the total construction cost of that facility as determined by agreement of the parties or by action brought in court.

   (Ga. L. 1949, p. 263, § 7; Ga. L. 1955, p. 410, § 6; Code 1933, § 88-2109, enacted by Ga. L. 1964, p. 499, § 1; Code 1933, § 88-2108, enacted by Ga. L. 1966, p. 716, § 1; Ga. L. 1985, p. 149, § 31; Ga. L. 2015, p. 385, § 4-6/HB 252.)

Editor's notes. - Ga. L. 2015, p. 385, § 1-1/HB 252, not codified by the General Assembly, provides that: "This Act shall be known and may be cited as the 'J. Calvin Hill, Jr., Act.' "

31-7-70. Short title.

This article shall be known and may be cited as the "Hospital Authorities Law."

(Code 1933, § 88-1801, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1996, p. 6, § 31.)

Administrative Rules and Regulations. - Rural Hospital Assistance Act, Official Compilation of the Rules and Regulations of the State of Georgia, Department of Community Health, Health Planning, Chapter 111-2-4.

Law reviews. - For article, "Local Government Law," see 53 Mercer L. Rev. 389 (2001).

31-7-71. Definitions.

As used in this article, the term:

1. "Area of operation" means the area within the city or county activating an authority.  Such term shall also mean any other city or county in which the authority wishes to operate, provided the governing authorities and the board of any hospital authorities of such city and county request or approve such operation.
2. "Authority" or "hospital authority" means any public corporation created by this article.
3. "Governing body" means the elected or duly appointed officials constituting the governing body of a city or county.
4. "Participating units" or "participating subdivisions" means any two or more counties, or any two or more municipalities, or a combination of any county and any municipality acting together for the creation of an authority.
5. "Project" includes the acquisition, construction, and equipping of hospitals, health care facilities, dormitories, office buildings, clinics, housing accommodations, nursing homes, rehabilitation centers, extended care facilities, and other public health facilities for the use of patients and officers and employees of any institution under the supervision and control of any hospital authority or leased by the hospital authority for operation by others to promote the public health needs of the community and all utilities and facilities deemed by the authority necessary or convenient for the efficient operation thereof. Such term may also include any such institutions, utilities, and facilities located outside the city or county in which the authority is located, provided that the acquisition, construction, equipping, and operation thereof is requested or approved by the governing bodies of such city and county in which the project is located and by the board of any hospital authorities located within such city and county or provided that the acquisition, construction, equipping, and operation is to be located in the area of operation of the authority.
6. "Resolution" means the resolution or ordinance to be adopted by governing bodies pursuant to which authorities are established.

   (Ga. L. 1941, p. 241, § 2; Code 1933, § 88-1802, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1969, p. 103, § 1; Ga. L. 1972, p. 683, § 1; Ga. L. 1973, p. 190, § 1; Ga. L. 1991, p. 1391, §§ 1, 2.)

31-7-72. Creation of hospital authority in each county and municipality.

1. There is created in and for each county and municipal corporation of the state a public body corporate and politic to be known as the "hospital authority" of such county or city, which shall consist of a board of not less than five nor more than nine members to be appointed by the governing body of the county or municipal corporation of the area of operation for staggered terms as specified by resolution of the governing body. The number of members of any hospital authority as of March 1, 1984, may be increased by not more than two additional members by the adoption of a resolution of the members of the hospital authority, and such additional members shall be appointed through the same process used for filling vacancies which was in effect for such hospital authority on January 1, 1984. Whenever an appointment to fill a vacancy on the board of any hospital authority is made, either for an unexpired term or a full term, consideration shall be given as to whether a licensed doctor of medicine or registered nurse currently serves on such authority. If no licensed doctor of medicine or registered nurse currently serves on such authority, then consideration shall be given to the nomination and choice of a licensed doctor of medicine or a registered nurse to fill such vacancy. No authority created under this Code section shall transact any business or exercise any powers under this Code section until the governing body of the area of operation shall, by proper resolution, declare that there is need for an authority to function in such county or municipal corporation. Copies of a resolution so adopted and any resolution adopted by the governing body providing for filling vacancies in the membership of the authority or making any changes in membership shall be filed with the department.
2. Appointments to fill vacancies on the board of any hospital authority activated on or after March 15, 1964, for either an unexpired or full term as fixed in the original resolution or ordinance creating the authority, shall be made as follows:
   1. The governing body of the area of operation shall submit a list of three eligible persons to the board of the hospital authority;
   2. The board at its next regular meeting shall either select one of the three persons named in such list or decline to select any of the persons named in the list. If the board declines to select any of the persons named on the list, it shall so notify the governing body; and
   3. Upon receipt of notification that the board has declined to select any of the persons named in the governing body's list, the governing body shall submit a second list of three eligible persons, no one of whom was named on the first list, to the board of the hospital authority. The board at its next regular meeting after receipt of the second list shall select one of the three persons named in the second list.
3. Appointments to fill vacancies for either an unexpired or full term on the boards of all hospital authorities in existence prior to March 15, 1964, shall be governed by the terms of a resolution adopted prescribing the manner by which vacancies are filled, unless changed by local legislation or constitutional amendment.
4. Any two or more counties or any two or more municipalities or any county or municipality, or a combination of any county and any municipality, by a like resolution or ordinance of their respective governing bodies, may authorize the exercise of the powers provided for in this article by an authority. The membership of such authority affected by like resolutions of the respective governing bodies of any two or more of the governing bodies of the participating units shall be not less than five nor more than 15 members, the terms and distribution of members between the participating units to be provided for by the resolutions adopted by the governing bodies of the participating units. The resolutions of the governing bodies of participating units acting together for the creation of an authority may be amended by the governing bodies of the participating units from time to time. Where the governing bodies of participating units have acted together for the creation of an authority under this subsection and where at least one of those participating units is a county having a population of 35,000 or less according to the United States decennial census of 1990 or any future such census, the method of filling vacancies upon such authority may be changed only by local Act of the General Assembly and, when so changed, shall be governed by that local Act.
5. 1. Nothing in this Code section is intended to invalidate any of the acts of existing boards of authorities. Hospital authorities shall be granted the same exemptions and exclusions from taxes as are now granted to cities and counties for the operation of facilities similar to facilities to be operated by hospital authorities as provided for under this title.
   2. Notwithstanding the provisions of paragraph (1) of this subsection or any other law to the contrary, any real property in which 50 percent or more of the floor space thereof, excluding halls, corridors, and public spaces, is rented or leased by persons, firms, or corporations engaged in or conducting a private for profit business or profession owned by a hospital authority which is located in a county having a population of 50,000 or more according to the United States decennial census of 1990 or any future such census or owned by any subsidiary or affiliate thereof and which hospital authority or subsidiary or affiliate thereof operates a hospital containing more than 100 beds, shall be subject to all state, county, and municipal ad valorem taxes in the same manner as other private property.
6. The project or projects of an authority created by two or more counties, or two or more municipalities, or a combination of any county and any municipality may be located outside of the area of the sponsor's operation when it is determined by the trustees that this will best serve the purposes of the facility and provided it is located within the area of service and within 12 miles of the hospital location or within 12 miles of the sponsoring county or municipality, whichever is farther.
7. Hospital authorities created pursuant to this Code section shall have perpetual existence.

   (Ga. L. 1941, p. 241, §§ 3, 4; Ga. L. 1949, p. 1141, §§ 1, 2; Code 1933, § 88-1803, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1965, p. 347, § 1; Ga. L. 1978, p. 1974, § 1; Ga. L. 1984, p. 585, § 1; Ga. L. 1991, p. 94, § 31; Ga. L. 1994, p. 781, § 1; Ga. L. 1998, p. 900, § 3.)

Law reviews. - For review of 1998 legislation relating to insurance, see 15 Ga. St. U. L. Rev. 143 (1998). For annual survey of real property law, see 68 Mercer L. Rev. 231 (2016).

31-7-72.1. Merger of hospital authorities.

1. A hospital authority activated for a county pursuant to Code Section 31-7-73 may be merged with a hospital authority activated for that county under Code Section 31-7-72 upon compliance with this Code section and approval by resolution of the governing authority of the county in which the authorities are located.  A majority of the board of each such hospital authority must approve such merger by a resolution which is adopted by each such board and is filed with the department.  That resolution shall set forth:
   1. The name of each hospital authority planning to merge and the name of the surviving hospital authority into which each plans to merge; and
   2. The terms and conditions of the planned merger.
2. The merger authorized by subsection (a) of this Code section shall not become effective until the governing authority of the county of operation of the merging hospitals appoints the members of the board of the surviving hospital authority by proper resolution and files copies of such resolution with the department.  The governing authority is not required but is authorized to appoint as a member of the surviving hospital authority any member of a hospital authority planning to merge.  The board of the surviving hospital shall consist of not more than 15 members with initial appointments for such staggered terms as provided in the resolution of the county governing authority.  Appointments to fill vacancies for either an unexpired or full term shall thereafter be filled as authorized for an authority under subsection (c) of Code Section 31-7-72.  The surviving hospital authority shall be in all other respects a hospital authority created under Code Section 31-7-72.
3. A county whose hospital authorities have merged under the authority of this Code section shall not thereafter be prohibited from activating a hospital authority under Code Section 31-7-73.
4. When a merger under this Code section takes effect:
   1. Each hospital authority party to the merger merges into the surviving hospital authority and the separate existence of each such hospital authority except the surviving hospital authority ceases;
   2. The ownership of and authority to operate the hospitals owned by each hospital authority and the title to all real estate and other property owned by each hospital authority party to the merger is vested in the surviving hospital authority without reversion or impairment subject to any and all conditions to which the property was subject prior to the merger;
   3. The surviving hospital authority has all liabilities and obligations of each hospital authority party to the merger; and
   4. A proceeding pending against any hospital authority party to the merger may be continued as if the merger did not occur or the surviving hospital authority may be substituted in the proceeding for the hospital authority whose existence ceased.
5. It is declared by the General Assembly of Georgia that in the exercise of the power specifically granted to them by this Code section, hospital authorities are acting pursuant to state policy and shall be immune from antitrust liability to the same degree and extent as enjoyed by the State of Georgia. (Code 1981, § 31-7-72.1 , enacted by Ga. L. 1993, p. 1020, § 1.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1993, a comma was deleted preceding "the title" in paragraph (d)(2).

31-7-73. Creation of additional hospital authority in counties with large populations.

1. Any other provision of this article to the contrary notwithstanding, there is created in and for each county of this state having a population of 100,000 or more according to the United States decennial census of 1970 or any future such census a public body corporate and politic to be known as the "__________ Hospital Authority." Each such hospital authority shall be a separate entity and in addition to the hospital authority of each county of this state created pursuant to Code Section 31-7-72.
2. Each such additional hospital authority shall consist of a board of not less than five nor more than nine members to be appointed by the governing body of each such county for staggered terms, as specified by resolution of the governing body. No hospital authority created under this Code section shall transact any business or exercise any powers under this Code section until the governing body of each such county declares by proper resolution that there is a need for an additional hospital authority to function within such county, which resolution shall also determine and declare that such hospital authority is being created pursuant to this Code section and shall adopt a designation for the hospital authority so as to reflect that it is a separate and distinct entity from the hospital authority created pursuant to Code Section 31-7-72. A copy of such resolution shall be filed with the department. Copies of any resolutions adopted by the governing body of the county for the purpose of filling vacancies in the membership of the hospital authority or for making any changes in membership shall also be filed with the department.
3. Appointments to fill vacancies on the board of any such hospital authority shall be made as provided in Code Section 31-7-72.
4. All provisions of this article, including, but not limited to, the rights, powers, duties, obligations, and exemptions from taxation provided thereby for hospital authorities shall apply to the additional hospital authorities created pursuant to this Code section and the hospital authorities so created shall, in all respects, to the extent applicable for the purposes of this chapter, be treated as though they had been created pursuant to Code Section 31-7-72.
5. It is declared that this Code section shall be cumulative of and supplemental to Code Section 31-7-72 and not in lieu thereof. It is expressly provided that nothing contained in this Code section shall invalidate or abrogate any of the actions or obligations of existing hospital authorities created pursuant to Code Section 31-7-72 and further that nothing contained in this Code section shall be construed as adversely affecting the rights and interests of the holders or owners of any bonds, certificates, or obligations now or hereafter issued by such existing hospital authorities.

   (Code 1933, § 88-1803.1, enacted by Ga. L. 1972, p. 683, § 2.)

31-7-74. Residency requirement; officers; compensation; rules and regulations.

The members of a hospital authority shall be residents of the participating units comprising the authority. The requirement of residence shall not apply to authorities activated under subsection (d) of Code Section 31-7-72, provided they are selected from within the area of service and within 12 miles of the hospital location or within 12 miles of the sponsoring county or municipality, whichever is farther. The members shall elect one of their number as chair and another as vice chair and shall also elect a secretary-treasurer, who need not be a member. The members shall receive no compensation for their services, either as members or as employees of the authority but may be reimbursed for their actual expenses incurred in the performance of their duties or, in the alternative, the members may elect to be reimbursed for such expenses on a per diem basis in an amount not to exceed $100.00 per meeting and the total amount not to exceed $100.00 per month. The authority shall make rules and regulations for its governance and may delegate to one or more of its members, officers, agents, or employees such powers and duties as may be deemed necessary and proper.

(Ga. L. 1941, p. 241, § 4; Code 1933, § 88-1804, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1965, p. 347, § 2; Ga. L. 1983, p. 1317, § 1; Ga. L. 1984, p. 874, § 1; Ga. L. 1997, p. 1404, § 2.)

31-7-74.1. Definitions; disclosures required; prohibited transactions; exceptions; sanctioning; sanctioning of members violating prohibition; authorization of authority to make stricter rules; preemption of other laws; applicability.

1. As used in this Code section, the term:
   1. "Family" means spouse, child, or sibling.
   2. "Financial interest" means the direct or indirect ownership of any assets or stock of any business.
   3. "Substantial interest" means the direct or indirect ownership of more than 25 percent of the assets or stock of any business.
   4. "Transact business" or "transact any business" or "transaction" means any sale or lease of any personal property, real property, or services on behalf of oneself or on behalf of any third party as an agent, broker, dealer, or representative.
2. Each member of a hospital authority shall disclose upon his or her selection as a member, and at least annually thereafter, the following described interests and relationships:
   1. Any financial interest held by the member or the member's family, or held by an entity in which the member or the member's family owns a financial interest, in any health care provider, any managed care provider or network, or any entity which sells products or services to the authority;
   2. Any position held by the member or the member's family as an officer, director, or employee of a hospital, hospital holding company, other health care provider, or managed care network; and
   3. Any contract which exists between the member or the member's family, or any entity in which the member or the member's family owns a financial interest, and the authority, including, but not limited to, supply contracts, service contracts, and leases.
3. Except as otherwise provided in this Code section, no authority member, no hospital chief executive, and no hospital system chief executive officer shall, for such person or for any entity in which such person or such person's family has a substantial interest, transact any business with such authority.
4. The prohibition of subsection (c) of this Code section shall not apply to:
   1. Any relationship whereunder a person licensed under Title 43 provides to such authority or its medical facilities any services;
   2. Any officer or employee of a trust company or bank which has been selected to be the depository of the funds of such nonprofit corporation; or
   3. Any transaction by a board member or a board member's family where the amount of all transactions between the parties is $1,000.00 or less in any one year.
5. A transaction in which any member of an authority has a financial interest or relationship described in subsection (b) of this Code section which does not constitute a substantial interest may be approved if, at the time of such approval:
   1. The material facts of the transaction and the member's financial interest are disclosed or known to the authority's board;
   2. The interested member is absent from any portion of a meeting which discusses or votes upon said transaction; and
   3. The members approving the transaction in good faith reasonably believe that the transaction is fair to the authority.
6. Notwithstanding the provisions of subsection (c) of this Code section, a transaction in which any member of an authority has a substantial interest may be approved if:
   1. The transaction was submitted to a competitive process for requests for proposals, which includes but is not limited to consideration of all submitted proposals for price, quality, and appropriateness; and
   2. Notice of the transaction was published in the official county organ not less than two weeks prior to the approval of the board;
   3. Opportunity for public comment concerning the proposed transaction was provided at a meeting of the board;
   4. At the time of approval, the members approving the transaction in good faith reasonably believe that the transaction is fair and is in the best interests of the authority; and
   5. The interested member is absent from any portion of a meeting which discusses or votes upon said transaction.
7. For purposes of this Code section, a transaction is authorized, approved, or ratified if it receives the affirmative vote of a majority of the members on the board present and voting who have no financial interest in the transaction. A majority, but not less than two, of all the noninterested members on the board present and voting constitutes a quorum for purposes of action that complies with this Code section.
8. Any action by an authority which is taken in compliance with the applicable requirements of this Code section may not be enjoined, set aside, or give rise to an award of damages or other sanctions against the authority or any member or officer on the ground of a member's or officer's interest in such transaction. For any action by an authority not in compliance with such requirements, any member knowingly violating such requirements shall be immediately sanctioned, which may include, but not be limited to, reprimand, temporary suspension, or permanent removal from the authority after appropriate notice and hearing. The entity having appointed such member shall have the authority to impose any sanction.
9. Nothing in this Code section shall prevent an authority from having stricter rules relating to interests or relationships than what is provided in this Code section.
10. To the extent the provisions of this Code section conflict with the provisions of any other law, the provisions of this Code section shall govern.
11. The provisions of this Code section shall apply to those individuals serving as members of an authority who are appointed or reappointed on or after July 1, 1997. However, this Code section shall apply to all members of an authority, regardless of appointment date, serving on or after July 1, 1998. (Code 1981, § 31-7-74.1 , enacted by Ga. L. 1997, p. 1404, § 3.)

31-7-74.2. Oath to be taken by members of hospital authority.

Each member of a hospital authority shall take in the presence of an officer authorized to administer same the following oath:

I, ______________________________, citizen of _____________ ______________ County, Georgia, do solemnly swear that I will, to the best of my ability, without favor or affection to any person and without any unauthorized financial gain or compensation to myself, faithfully and fairly discharge all of the duties and responsibilities that devolve upon me as a member of ______________________________ Hospital Authority, during the term of my service as such member.

(Code 1981, § 31-7-74.2 , enacted by Ga. L. 1997, p. 1404, § 3.)

31-7-74.3. Sale or lease by hospital authority; hearing required; factors to be considered at hearing; applicability; requirements for lease.

1. No hospital which is owned by a hospital authority may be sold or leased to a for profit entity, a not for profit entity, or another hospital authority unless a public hearing regarding such action is held in the county where such hospital is located at least 60 days prior to such sale or lease becoming effective. In the event there is more than one participating unit for an authority, a hearing shall be held in each participating unit's county at least 60 days prior to the sale or lease becoming effective. The hospital authority must publish notice of the hearing at least three times, with the first such notice appearing at least 60 days prior to the hearing in the legal organ of each participating unit. At each such public hearing, the hospital authority shall describe, discuss, or otherwise disclose:
   1. The reasonably foreseeable adverse and beneficial effects of such lease or sale upon health care in the service area of the hospitals to be leased or sold, and, for purposes of this paragraph, the service area shall include the county in which the hospital is located and each adjoining county;
   2. A financial statement indicating the estimated value of the total assets and liabilities to be transferred or received in the transaction; however, if the value of any individual asset exceeds $100,000.00, a description and the value of such assets shall be indicated on the financial statement; and
   3. The resumes of the top five executive officers who will manage the facility after it is sold or leased.

      This subsection shall not apply to any transaction which is subject to the provisions of Code Section 31-7-89.1.

2. No hospital which is owned by a hospital authority may be leased to another person, corporation, or business entity, other than as provided in paragraphs (23) and (24) of Code Section 31-7-75, unless such lease requires that:
   1. At least one member of the hospital authority will serve as a full voting member upon the governing body or local board of the business entity exercising control and management powers over the leased hospital; and
   2. The governing body or local board of the business entity exercising control and management powers over the leased hospital submits to the governing authority of each county in which the hospital is located, within 90 days after the close of the calendar year or that entity's fiscal year, a complete and detailed financial statement for that entity.
3. Provisions of a lease required by subsection (b) of this Code section may not be renegotiated or otherwise altered or amended for the duration of such lease. (Code 1981, § 31-7-74.3 , enacted by Ga. L. 1997, p. 1404, § 3; Ga. L. 1998, p. 128, § 31.)

31-7-74.4. Board members deemed directors upon sale or lease of hospital.

Members on the board of a hospital authority at the time of a sale or lease of a hospital owned by such hospital authority shall be deemed directors and subject to the provisions of Part 6 of Article 8 of Chapter 3 of Title 14, relating to conflicting interest transactions with respect to the proceeds of such sale or lease.

(Code 1981, § 31-7-74.4 , enacted by Ga. L. 2019, p. 183, § 2/HB 321.)

Effective date. - This Code section became effective April 25, 2019.

31-7-75. Functions and powers.

Every hospital authority shall be deemed to exercise public and essential governmental functions and shall have all the powers necessary or convenient to carry out and effectuate the purposes and provisions of this article, including, but without limiting the generality of the foregoing, the following powers:

1. To sue and be sued;
2. To have a seal and alter the same;
3. To make and execute contracts and other instruments necessary to exercise the powers of the authority;
4. To acquire by purchase, lease, or otherwise and to operate projects;
5. To construct, reconstruct, improve, alter, and repair projects;
6. To sell to others, or to lease to others for any number of years up to a maximum of 40 years, any lands, buildings, structures, or facilities constituting all or any part of any existing or hereafter established project. In the event a hospital authority undertakes to sell a hospital facility, such authority shall, prior to the execution of a contract of sale, provide reasonable public notice of such sale and provide for a public hearing to receive comments from the public concerning such sale. This power shall be unaffected by the language set forth in paragraph (13) of this Code section or any implications arising therefrom unless grants of assistance have been received by the authority with respect to such lands, buildings, structures, or facilities, in which case approval in writing as set forth in paragraph (13) of this Code section shall be obtained prior to selling or leasing to others within 20 years after completion of construction;
7. To lease for any number of years up to a maximum of 40 years for operation by others any project, provided that the authority shall have first determined that such lease will promote the public health needs of the community by making additional facilities available in the community or by lowering the cost of health care in the community and that the authority shall have retained sufficient control over any project so leased so as to ensure that the lessee will not in any event obtain more than a reasonable rate of return on its investment in the project, which reasonable rate of return, if and when realized by such lessee, shall not contravene in any way the mandate set forth in Code Section 31-7-77 specifying that no authority shall operate or construct any project for profit. Any lessee shall agree in the lease to pay rent sufficient in each year to pay the principal of and the interest on any revenue anticipation certificates proposed to be issued to finance the cost of the construction or acquisition of any such project and to pay off or refinance, in whole or in part, any outstanding debt or obligation of the lessee (including any redemption or prepayment premium due thereon) which was incurred in connection with the acquisition and construction of facilities of such lessee and the amount necessary in the opinion of the authority to be paid each year into any reserve funds which the authority may deem advisable to be established in connection with the retirement of the proposed revenue anticipation certificates and the maintenance of the project. Any such lease shall further provide that the cost of all insurance with respect to the project and the cost of maintenance and repair thereof shall be borne by the lessee. In carrying out a refinancing plan with regard to any outstanding debt or obligation of the lessee which was incurred in connection with the acquisition and construction of facilities of such lessee, the authority may use proceeds of any revenue anticipation certificates issued for such purpose to acquire such outstanding debt or obligation, in whole or in part, and may itself or through a fiduciary or agent hold and pledge such acquired debt or obligation as security for the payment of such revenue anticipation certificates. The powers granted in this paragraph shall be unaffected by the language set forth in paragraph (13) of this Code section or any implications arising therefrom unless grants of assistance have been received by the authority with respect to such project, in which case approval in writing as set forth in paragraph (13) of this Code section shall be obtained prior to leasing to others within 20 years after completion of construction. Any revenues derived by the authority from any such lease shall be applied by the authority to the payment of any revenue anticipation certificates issued in connection with the acquisition and construction of the project and the payment, in whole or in part, of any outstanding debt or obligation of the lessee which was incurred in connection with the acquisition and construction of facilities of such lessee (including any redemption or prepayment premium due thereon) or to the payment of any other expenses incurred in connection with acquiring, financing, maintaining, expanding, operating, or equipping the project;
8. To extend credit or make loans to others for the planning, design, construction, acquisition, or carrying out of any project, which credit or loans may be secured by such loan agreements, mortgages, security agreements, contracts, or other instruments or fees or charges, for a term not to exceed 40 years, and upon such terms and conditions as the authority shall determine reasonable in connection with such loans, including provisions for the establishment and maintenance of reserves and insurance funds, and in the exercise of powers granted by this Code section in connection with a project, to require the inclusion in any contract, loan agreement, security agreement, or other instrument such provisions for guaranty, insurance, construction, use, operation, maintenance, and financing of a project as the authority may deem necessary or desirable;
9. To acquire, accept, or retain equitable interests, security interests, or other interests in any property, real or personal, by mortgage, assignment, security agreement, pledge, conveyance, contract, lien, loan agreement, or other consensual transfer in order to secure the repayment of any moneys loaned or credit extended by the authority;
10. To establish rates and charges for the services and use of the facilities of the authority;
11. To accept gifts, grants, or devises of any property;
12. To acquire by the exercise of the right of eminent domain any property essential to the purposes of the authority;
13. To sell or lease within 20 years after the completion of construction of properties or facilities operated by the hospital authority where grants of financial assistance have been received from federal or state governments, after such action has first been approved by the department in writing;
14. To exchange, transfer, assign, pledge, mortgage, or dispose of any real or personal property or interest therein;
15. To mortgage, pledge, or assign any revenue, income, tolls, charges, or fees received by the authority;
16. To issue revenue anticipation certificates or other evidences of indebtedness for the purpose of providing funds to carry out the duties of the authority; provided, however, that the maturity of any such indebtedness shall not extend for more than 40 years;
17. To borrow money for any corporate purpose;
18. To appoint officers, agents, and employees;
19. To make use of any facilities afforded by the federal government or any agency or instrumentality thereof;
20. To receive, from the governing body of political subdivisions issuing the same, proceeds from the sale of general obligation bonds or other county obligations issued for hospital authority purposes;
21. To exercise any or all powers now or hereafter possessed by private corporations performing similar functions;
22. To make plans for unmet needs of their respective communities;
23. To contract for the management and operation of the project by a professional hospital or medical facilities consultant or management firm. Each such contract shall require the consultant or firm contracted with to post a suitable and sufficient bond;
24. To provide management, consulting, and operating services including, but not limited to, administrative, operational, personnel, and maintenance services to another hospital authority, hospital, health care facility, as said term is defined in Chapter 6 of this title, person, firm, corporation, or any other entity or any group or groups of the foregoing; to enter into contracts alone or in conjunction with others to provide such services without regard to the location of the parties to such transactions; to receive management, consulting, and operating services including, but not limited to, administrative, operational, personnel, and maintenance services from another such hospital authority, hospital, health care facility, person, firm, corporation, or any other entity or any group or groups of the foregoing; and to enter into contracts alone or in conjunction with others to receive such services without regard to the location of the parties to such transactions;
25. To provide financial assistance to individuals for the purpose of obtaining educational training in nursing or another health care field if such individuals are employed by, or are on an authorized leave of absence from, such authority or have committed to be employed by such authority upon completion of such educational training; to provide grants, scholarships, loans or other assistance to such individuals and to students and parents of students for programs of study in fields in which critical shortages exist in the authority's service area, whether or not they are employees of the authority; to provide for the assumption, purchase, or cancellation of repayment of any loans, together with interest and charges thereon, made for educational purposes to students, postgraduate trainees, or the parents of such students or postgraduate trainees who have completed a program of study in a field in which critical shortages exist in the authority's service area; and to provide services and financial assistance to private not for profit organizations in the form of grants and loans, with or without interest and secured or unsecured at the discretion of such authority, for any purpose related to the provision of health or medical services or related social services to citizens;
26. To exercise the same powers granted to joint authorities in subsection (f) of Code Section 31-7-72; and
27. To form and operate, either directly or indirectly, one or more networks of hospitals, physicians, and other health care providers and to arrange for the provision of health care services through such networks; to contract, either directly or through such networks, with the Department of Community Health to provide services to Medicaid beneficiaries to provide health care services in an efficient and cost-effective manner on a prepaid, capitation, or other reimbursement basis; and to undertake other managed health care activities; provided, however, that for purposes of this paragraph only and notwithstanding the provisions of Code Section 33-3-3, as now or hereafter amended, a hospital authority shall be permitted to and shall comply with the requirements of Chapter 21 of Title 33 to the extent that such requirements apply to the activities undertaken by the hospital authority pursuant to this paragraph. No hospital authority, whether or not it exercises the powers authorized by this paragraph, shall be relieved of compliance with Article 4 of Chapter 18 of Title 50, relating to inspection of public records unless otherwise authorized by law. Any health care provider licensed under Chapter 30 of Title 43 shall be eligible to apply to become a participating provider under such a hospital plan or network which provides coverage for health care services which are within the lawful scope of his or her practice, provided that nothing contained in this Code section shall be construed to require any such hospital plan or network to provide coverage for any specific health care service.

    (Ga. L. 1941, p. 241, § 5; Ga. L. 1945, p. 349, § 1; Ga. L. 1957, p. 116, § 1; Code 1933, § 88-1805, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1964, Ex. Sess., p. 15, § 1; Ga. L. 1969, p. 103, § 2; Ga. L. 1969, p. 805, § 1; Ga. L. 1978, p. 1970, § 1; Ga. L. 1980, p. 1140, § 1; Ga. L. 1982, p. 712, §§ 1, 2; Ga. L. 1983, p. 3, § 22; Ga. L. 1983, p. 1566, § 2; Ga. L. 1990, p. 310, § 1; Ga. L. 1991, p. 1391, § 3; Ga. L. 1995, p. 901, § 1; Ga. L. 1999, p. 296, § 24; Ga. L. 2003, p. 569, § 2.)

Cross references. - Certificate of need required for offering of health care facilities and services, § 31-6-40 .

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2001, "not for profit" was substituted for "not-for-profit" in paragraph (25).

Law reviews. - For survey article on local government law, see 34 Mercer L. Rev. 225 (1982). For annual survey of local government law, see 35 Mercer L. Rev. 233 (1983).

31-7-75.1. (For effective date, see note.) Proceeds of sale of hospital held in trust to fund indigent health care.

1. The proceeds from any sale or lease of a hospital owned by a hospital authority or political subdivision of this state, which proceeds shall not include funds required to pay off the bonded indebtedness of the sold hospital or any expense of the authority or political subdivision attributable to the sale or lease, shall be held by the authority or political subdivision in an irrevocable trust fund. Such proceeds in that fund may be invested in the same way that public moneys may be invested generally pursuant to general law and as permitted under Code Section 31-7-83, but money in that trust fund shall be used exclusively for funding the provision of health care for the indigent residents of the political subdivision which owned the hospital or by which the authority was activated or for which the authority was created. If the funds available for a political subdivision in that irrevocable trust fund are less than $100,000.00, the principal amount may be used to fund the provision of indigent health care; otherwise, only the income from that fund may be used for that care. Such funding or reimbursement for indigent care shall not exceed the diagnosis related group rate for that hospital in each individual case.
2. In the event a hospital authority which sold or leased a hospital was activated by or created for more than one political subdivision or in the event a hospital having as owner more than one political subdivision is sold or leased by those political subdivisions, each such constituent political subdivision's portion of the irrevocable trust fund for indigent health care shall be determined by multiplying the amount of that fund by a figure having a numerator which is the population of that political subdivision and a denominator which is the combined population of all the political subdivisions which owned the hospital or by which or for which the authority was activated or created.
3. (For effective date, see note.) For purposes of health care for the indigent under this Code section, the standard of indigency shall be defined as income that is at or below 138 percent of the federal poverty level based on the poverty guidelines established by the United States Department of Health and Human Services.
4. This Code section shall not apply to the following actions:
   1. A reorganization or restructuring;
   2. Any sale of a hospital, or the proceeds from that sale, made prior to April 2, 1986; and
   3. Any sale or lease of a hospital when the purchaser or lessee pledges, by written contract entered into concurrently with such purchase or lease, to provide an amount of health care equal to that which would have otherwise been available pursuant to subsections (a), (b), and (c) of this Code section for the indigent residents of the political subdivisions which owned the hospital, by which the hospital authority was activated, or for which the authority was created. However, the exception to this Code section provided by this paragraph shall only apply to:
      1. Hospital authorities that operate a licensed hospital pursuant to a lease from the county which created the appropriate authority;
      2. Hospitals that have a bed capacity of more than 150 beds;
      3. Hospitals located in a county in which no other medical-surgical licensed hospital is located;
      4. Hospitals located in a county having a population of less than 45,000 according to the United States decennial census of 1990; and
      5. Hospitals operated by a hospital authority that entered into a lease-purchase agreement between such hospital and a private corporation prior to July 1, 1997. (Code 1981, § 31-7-75.1 , enacted by Ga. L. 1986, p. 744, § 2; Ga. L. 1996, p. 739, § 1; Ga. L. 2019, p. 148, § 3-1/HB 186; Ga. L. 2020, p. 220, § 1/SB 395.)

Delayed effective date. - Subsection (c), as set out above, becomes effective January 1, 2021. For version of subsection (c) in effect until January 1, 2021, see the 2020 amendment note.

The 2019 amendment, effective July 1, 2019, substituted "health care" for "hospital care" throughout this Code section; inserted "and as permitted under Code Section 31-7-83" near the middle of the second sentence of subsection (a); and deleted "and" at the end of subparagraphs (d)(3)(A) through (d)(3)(C).

The 2020 amendment, effective January 1, 2021, substituted "defined as income that is at or below 138 percent of the federal poverty level based on the poverty guidelines established by the United States Department of Health and Human Services" for "that determined under Code Section 31-8-43, relating to standards of indigency for emergency care of pregnant women, based upon 125 percent of the federal poverty level" in subsection (c).

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1986, a hyphen was deleted from between "diagnosis" and "related" in the last sentence of subsection (a).

31-7-75.2. Exemption from disclosure for potentially commercially valuable plan, proposal, or strategy.

Notwithstanding any other provision of law to the contrary, no Georgia nonprofit corporation in its operation of a hospital or other medical facility for the benefit of a governmental entity in this state and no hospital authority shall be required by Chapter 14 of Title 50 or Article 4 of Chapter 18 of Title 50 to disclose or make public any potentially commercially valuable plan, proposal, or strategy that may be of competitive advantage in the operation of the corporation or authority or its medical facilities and which has not been made public. This exemption shall terminate at such time as such plan, proposal, or strategy has either been approved or rejected by the governing board of such corporation or hospital authority. Except as provided in this Code section or as otherwise provided by law, hospital authorities shall comply with the provisions of Chapter 14 of Title 50 and Article 4 of Chapter 18 of Title 50.

(Code 1981, § 31-7-75.2 , enacted by Ga. L. 1989, p. 553, § 1; Ga. L. 1993, p. 1020, § 2; Ga. L. 2001, p. 1172, § 1.)

Law reviews. - For note on 1989 enactment of this Code section, see 6 Ga. St. U. L. Rev. 324 (1989). For note on the 2001 amendment to this Code section, see 18 Ga. St. U. L. Rev. 162 (2001).

31-7-75.3. Home health agency services operated by hospitals.

Repealed by Ga. L. 2007, p. 47, § 31(1)/SB 103, effective May 11, 2007.

Editor's notes. - This Code section was based on Code 1981, § 31-7-75.3 , enacted by Ga. L. 1998, p. 900, § 4.

31-7-76. Procedure in event of failure of authority to perform minimum functions; determination of removal from office; appointments to fill vacancies created by removal.

1. The General Assembly declares that it is the intent of this article to provide a mechanism for the operation and maintenance of needed health care facilities in the several counties and municipalities of this state. It is the further intent of the General Assembly that, whenever an authority ceases to perform the minimum functions required for the continued operation and maintenance of needed health care facilities in the county or municipality, a procedure be made available to recognize the failure of the authority to perform these minimum functions and to provide for the orderly and responsible reorganization of the authority.
2. Whenever it appears that an authority has ceased to perform the minimum functions required for the continued operation and maintenance of needed health care facilities in the county or municipality in which the authority is authorized to function, a petition may be filed in the superior court in the county requesting that the members of the authority be removed from office and that any vacancy created by a removal be filled as provided in Code Section 31-7-72 for the initial appointment of members of an authority. Each such petition shall be filed by one or more residents of the county in which the authority is authorized to function, or by the county governing authority, and shall be supported by petition of a number of residents of the county equal to 5 percent or more of the number of electors registered to vote in the general election last held in the county. In the case of an authority authorized to function solely within a municipality, the petition shall be filed by one or more residents of the municipality in which the authority is authorized to function, or by the municipal governing authority, and shall be supported by petition of a number of residents of the municipality equal to 5 percent or more of the number of electors registered to vote in the general election last held in the municipality.
3. Upon the filing of any petition as provided in subsection (b) of this Code section, the judge of the superior court shall set a hearing to inquire into the merits of the petition not sooner than ten days nor later than 30 days from the date of filing of the petition. The hearing may be continued, in the discretion of the judge, on motion of any party.
4. At each hearing held as provided in subsection (c) of this Code section, the judge, sitting without a jury, shall inquire into and determine the question of whether the authority has ceased to perform the minimum functions required for the continued operation and maintenance of needed health care facilities in the county or municipality. In making his determination the judge shall consider, but shall not be limited by, whether the authority has:
   1. Failed to establish and enforce rates and charges as provided in Code Section 31-7-77;
   2. Failed to take any reasonable action when the failure has the effect of jeopardizing repayment of principal or interest, when due, on revenue anticipation certificates issued by the authority;
   3. Failed to take any reasonable action when the failure has the effect of breaching a contract providing for continued maintenance and use of the authority's facilities and entered into with a county or municipality as provided in Code Section 31-7-85;
   4. Failed to make plans for unmet needs of the community as authorized by paragraph (22) of Code Section 31-7-75;
   5. Failed to make and file its annual report as provided in Code Section 31-7-90;
   6. Failed to adopt an annual budget as provided in Code Section 31-7-90;
   7. Failed to conduct the annual audit as provided in Code Section 31-7-91;
   8. Failed to report or publish the annual audit as provided in Code Section 31-7-92;
   9. Failed to hold at least one meeting in the preceding calendar quarter; or
   10. Failed to take any other action required pursuant to this article.
5. After giving all parties an opportunity to be heard, the judge shall determine, based on the evidence presented, whether the clear and convincing weight of the evidence is that the authority has ceased to perform the minimum functions required for the continued operation and maintenance of needed health care facilities in the county or municipality. In the event the judge so decides, he shall order the immediate removal from office of the members of the authority, except that no member shall be removed who demonstrates to the satisfaction of the judge his good faith attempt to fulfill his duties as a member of the authority. In the event the court denies the petition, the petition shall be dismissed.
6. Vacancies created pursuant to this Code section shall be filled in the same manner as provided in Code Section 31-7-72 for the initial appointment of members of an authority. Vacancies created by the expiration of the term or the resignation or disability of a member appointed pursuant to this Code section shall be filled as provided in Code Section 31-7-72 for the filling of vacancies.

   (Code 1933, § 88-1804.1, enacted by Ga. L. 1978, p. 2009, § 1; Ga. L. 1984, p. 22, § 31.)

31-7-77. Prohibition on for-profit projects; rates and charges; utilization of revenues to pay certain obligations.

1. No authority shall operate or construct any project for profit. It shall fix rates and charges consistent with this declaration of policy and such as will produce revenues only in amounts sufficient, together with all other funds of the authority, to pay principal and interest on certificates and obligations of the authority, to provide for maintenance and operation of the project, and to create and maintain a reserve sufficient to meet principal and interest payments due on any certificates in any one year after the issuance thereof. The authority may provide reasonable reserves for the improvement, replacement, or expansion of its facilities or services.
2. Notwithstanding subsection (a) of this Code section or any other provisions to the contrary, a joint hospital authority established pursuant to Code Section 31-7-72 which operates a hospital containing more than 900 licensed beds shall only utilize revenues to pay principal and interest on certificates and obligations of the authority, to pay pension plan obligations of the authority existing as of January 1, 2013, and for funding projects leased by the authority to a lessee pursuant to a contract entered into in accordance with paragraph (7) of Code Section 31-7-75; provided, however, that no more than 1 percent of revenues shall be utilized to pay for personnel costs for employees or contractors of the authority.

   (Ga. L. 1941, p. 241, § 6; Code 1933, § 88-1806, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 2013, p. 1037, § 1/SB 62.)

31-7-78. Issuance and sale of negotiable revenue anticipation certificates.

1. Every authority is authorized to provide by resolution for the issuance and sale of negotiable revenue anticipation certificates for the purpose of:
   1. Paying all or any part of the cost of the acquisition, construction, alteration, repair, modernization, and other charges incident thereto in connection with any facilities or project;
   2. Paying all or any part of the cost of paying off or refinancing any outstanding debt or obligation of any nature owed by such authority or by persons who in furtherance of the authority's public purposes lease facilities from such authority pursuant to this article, provided that such outstanding debt or obligation was incurred in connection with the acquisition or construction of facilities of the authority or any such lessee; and
   3. Refunding outstanding certificates.
2. In addition to paying from the proceeds of any revenue anticipation certificate issue interest accrued during the construction period of any project and other incidental and customary expenses such as those for engineering, inspections, and fiscal and legal services, the authority may fund as a part of such issue and set aside from the proceeds thereof an amount of money not exceeding 15 percent of the principal amount of such issue for the purpose of establishing a debt service reserve with respect to the principal and interest requirements of such issue. The authority may issue such types of certificates as it determines appropriate, including certificates on which principal and interest are payable:
   1. Exclusively from income or revenues of the operation of the authority financed with the proceeds of such certificates or together with such proceeds and grants from the federal government, or any instrumentality, or other person or corporation in aid of such projects;
   2. Exclusively from income and revenues of certain designated projects; or
   3. From revenues of the authority generally, including any debt service reserve established with a portion of the certificate proceeds.

      Any such certificate may be additionally secured by the hypothecation of any revenues received from participating units or subdivisions and by mortgage of the project or any part thereof constituting real or personal property of the authority, except as prohibited by law.

      (Ga. L. 1941, p. 241, § 7; Ga. L. 1955, p. 618, § 1; Code 1933, § 88-1807, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1980, p. 1140, § 2.)

31-7-79. Liability on revenue certificates; tax exemption.

Neither the members of an authority nor any person executing certificates on behalf of an authority shall be personally liable thereon by reason of the issuance thereof. The certificates and other obligations of an authority shall not be, and shall so state on the face thereof, a debt of the city, the county, the state or any political subdivision thereof, or any combination of subdivisions acting jointly as provided in this article. Certificates of any authority are declared to be issued for an essential public and governmental purpose and, together with interest thereon and income therefrom, shall be exempt from all taxes.

(Ga. L. 1941, p. 241, § 7; Ga. L. 1955, p. 618, § 1; Code 1933, § 88-1808, enacted by Ga. L. 1964, p. 499, § 1.)

Law reviews. - For article, "Hospital Liability for Physician Negligence in Georgia: A Realistic Approach," see 37 Mercer L. Rev. 701 (1986).

31-7-80. Form and contents of revenue certificates; validity of signatures thereon.

Certificates of an authority shall be authorized by its resolution and may be issued in one or more series and shall bear such date or dates; mature at such time or times; bear interest at such rate or rates not exceeding 9 percent per annum; be in such denomination or denominations; be in such form, either coupon or registered; carry such conversion or registration privileges; have such rank or priority; be executed in such manner; be payable in such medium of payment, at such place or places; and be subject to such terms of redemption, with or without premium, as such resolution, its trust indenture, or mortgage may provide. In the event that any of the members or officers of the authority whose signatures appear on any certificates or coupons shall cease to be such members or officers before the delivery of such certificates, such signatures shall nevertheless be valid and sufficient for all purposes.

(Ga. L. 1941, p. 241, § 8; Ga. L. 1957, p. 485, § 1; Code 1933, § 88-1809, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1968, p. 1097, § 1; Ga. L. 1970, p. 144, § 1.)

Cross references. - Repeal of interest rate limitations, § 36-82-123 .

31-7-81. Confirmation and validation of revenue certificates.

1. Certificates of an authority shall be confirmed and validated in accordance with the procedure of Article 3 of Chapter 82 of Title 36; and, when validated, the judgment of validation shall be final and conclusive with respect to such certificates and against the authority issuing the same.
2. In the event that the payments to be made by any city or county, under contract entered into between the authority and the subdivision, are pledged to the security or payment of revenue certificates sought to be validated, the hospital authority, as an integral part of the validation proceedings, shall have a right of action against the contracting subdivision or subdivisions for a declaratory adjudication of the validity and binding effect of the contract, the actual controversy therein being whether or not the contract is in all respects valid and binding upon the subdivision or subdivisions. The subdivision or subdivisions shall be made a party or parties to the action, and it shall be incumbent on the subdivisions to defend against an adjudication of the validity of such contract or be forever bound. Notice of the proceedings shall be included in the notice of validation hearing required to be issued and published by the clerk of the superior court in which such validation proceeding is pending. Any citizen resident in any subdivision which is a party to the contract may intervene in the validation proceedings at or before the time set for the validation hearing by order of the superior court and assert any ground or objection to the validity and binding effect of the contract on his own behalf and on behalf of the subdivision and all citizens, residents, and property owners thereof. An adjudication as to the validity of the contract, unexcepted to within the time provided for exceptions in Article 3 of Chapter 82 of Title 36, shall be conclusive and binding upon the subdivision or subdivisions and the resident citizens and property owners thereof.

   (Ga. L. 1941, p. 241, § 12; Ga. L. 1955, p. 618, § 3; Code 1933, § 88-1810, enacted by Ga. L. 1964, p. 499, § 1.)

Cross references. - Venue for proceedings to confirm and validate revenue bonds issued by hospital authority, § 36-82-83 .

31-7-82. Enforcement of rights of revenue certificate holders; procedure in event of default.

Obligations of an authority evidenced by certificates and trust indentures and mortgages executed in connection therewith may contain such provisions not inconsistent with law as shall be determined by the authority. The authority may in such instruments provide for pledging of all or any part of its gross or net fees, tolls, charges, revenues, and incomes and for mortgaging of all or any part of its real or personal property and may covenant against pledging any or all of its income, revenues, tolls, charges, or fees; and the authority may further provide for the disposition of proceeds realized from the sale of any mutilated certificates and necessary provisions as to payment and redemption of such certificates. Undertakings of an authority may likewise prescribe the procedure by which certificate holders may enforce rights against the authority and provide for such rights upon breach of any covenant, condition, or obligation of the authority. Trust indentures, mortgages, or deeds to secure debt executed by an authority may provide that, in the event of default by the authority in the payment of principal and interest on certificates or obligations or breach of any covenant, a trustee or trustees appointed under the terms of the indenture, mortgage, or deed to secure debt, which shall be a bank or trust company authorized to exercise trust powers, may take possession of and use, operate, and manage any project mortgaged as security for the repayment of any indebtedness of the authority and provide the terms and conditions upon which the trustee or trustees or holders of certificates may enforce any right relating to such certificates. Such trust indentures, mortgages, and deeds to secure debt may contain such provisions, not inconsistent with law, as may be deemed necessary or desirable by the authority.

(Ga. L. 1941, p. 241, § 9; Code 1933, § 88-1811, enacted by Ga. L. 1964, p. 499, § 1.)

31-7-83. (For effective date, see note.) Investment of surplus moneys and moneys received through issuance of revenue certificates.

1. Pending use for the purpose for which received, each hospital authority created by and under this article is authorized and empowered to invest all moneys or any part thereof received through the issuance and sale of revenue certificates of the authority in any securities which are legal investments or which are provided for in the trust indenture securing such certificates or other legal investments; provided, however, that such investments shall be used at all times while held, or upon sale, for the purposes for which the money was originally received and no other. Contributions or gifts received by any authority shall be invested as provided by the terms of the contribution or gift or in the absence thereof as determined by the authority.
2. In addition to the authorized investments in subsection (a) of this Code section and in Code Section 36-83-4, hospital authorities that have ceased to own or operate medical facilities for a minimum of seven years, have paid off all bonded indebtedness and outstanding short-term or long-term debt obligations, and hold more than $20 million in funds for charitable health care purposes may invest a maximum of 30 percent of their funds in the following:
   1. Shares of mutual funds registered with the Securities and Exchange Commission of the United States under the Investment Company Act of 1940, as amended; and
   2. Commingled funds and collective investment funds maintained by state chartered banks or trust companies or regulated by the Office of the Comptroller of the Currency of the United States Department of the Treasury, including common and group trusts, and, to the extent the funds are invested in such collective investment funds, the funds shall adopt the terms of the instruments establishing any group trust in accordance with applicable United States Internal Revenue Service Revenue Rulings.
3. (For effective date, see note.) In addition to the authorized investments in subsection (a) of this Code section and in Code Section 36-83-4, hospital authorities that have paid off all bonded indebtedness and outstanding short-term or long-term debt obligations and hold an irrevocable trust wherein the corpus of such trust is $75 million or more, irrespective of the source of the funds held in the corpus, may invest a maximum of 30 percent of their funds in the following:
   1. Shares of mutual funds registered with the Securities and Exchange Commission of the United States under the Investment Company Act of 1940, as amended; and
   2. Commingled funds and collective investment funds maintained by state chartered banks or trust companies or regulated by the Office of the Comptroller of the Currency of the United States Department of the Treasury, including common and group trusts, and, to the extent the funds are invested in such collective investment funds, the funds shall adopt the terms of the instruments establishing any group trust in accordance with applicable United States Internal Revenue Service Revenue Rulings.
4. (For effective date, see note.) In addition to the authorized investments in subsection (a) of this Code section and in Code Section 36-83-4, hospital authorities that hold an irrevocable trust wherein the corpus of such trust is $100 million or more may invest its funds, subject to all the terms, conditions, limitations, and restrictions imposed by Article 7 of Chapter 20 of Title 47, the "Public Retirement Systems Investment Authority Law" for large retirement systems, provided that:
   1. The trust investments held by the hospital authority are managed by one or more independent professional investment managers recognized by the National Association of Securities Dealers and the United States Securities and Exchange Commission and which adhere to the code of ethical standards and conduct of the Association for Investment Management and Research; and
   2. The trust investments are limited to those equities of investment grade quality or better, provided that leverage techniques, option techniques, futures, commodities, private placements, and direct participation plans may not be used when making equity investments.

      (Ga. L. 1947, p. 1138, § 1; Code 1933, § 88-1820, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1969, p. 805, § 2; Ga. L. 2019, p. 148, § 3-2/HB 186; Ga. L. 2020, p. 220, § 2/SB 395.)

Delayed effective date. - Subsections (c) and (d), as set out above, become effective January 1, 2021. Until January 1, 2021, there is no subsection (c) or (d).

The 2019 amendment, effective July 1, 2019, designated the existing provisions as subsection (a); substituted "shall" for "will" in the proviso of the first sentence of subsection (a); and added subsection (b).

The 2020 amendment, effective January 1, 2021, added subsections (c) and (d).

31-7-84. Payment for authority's services and facilities; levy of tax by political subdivisions; compliance by authority with county budgetary procedures.

1. An authority shall have no power to tax, but upon the adoption of the resolution by the governing body or bodies of participating units or subdivisions as provided in this article and the execution of a contract for the use of facilities and services of the authority by political subdivisions or participating units as authorized in Code Section 31-7-85, provision shall be made annually by such participating units or political subdivisions contracting with an authority for the payment for the services and facilities of the authority used by the participating units or subdivisions or the residents thereof out of general funds of the participating units or subdivisions or out of tax revenues realized for the purpose of providing medical care or hospitalization for the indigent sick and others entitled to the use of the services and facilities of the authority.
2. For the purpose of providing such tax revenues as specified above, there is authorized to be levied an ad valorem tax not exceeding seven mills, exclusive of all other taxes which may be levied by counties or by cities or by towns, from which revenues when realized there shall be appropriated annually sums sufficient to pay for the cost of the use of the services and facilities of authorities by participating subdivisions or the residents thereof pursuant to the provisions and covenants of the contract between such participating units and subdivisions and authorities. In determining the cost of such services and facilities furnished pursuant to such contract, there may be included, but without limiting same, the following:
   1. The cost of acquiring, constructing, altering, repairing, renovating, improving, and equipping projects; and
   2. Principal, interest, and sinking fund and other reserve requirements in connection with the issuance of revenue certificates, bonds, or obligations by authorities to finance, in whole or in part, the cost of projects and the payment of expenses incident thereto; the cost of operating, maintaining, and repairing such projects; and the cost of retiring, refinancing, or refunding any outstanding debt or other obligation of any nature incurred by such authorities.
3. Whenever the fiscal operations of any county falling within the classification of this chapter are governed by any statutory budget law applicable to the fiscal affairs and budget of such county, the governing authorities of such county shall have full power and authority hereunder to require the hospital authority to conform, in whole or in part, to the same budgetary procedures as are made binding by statute upon the county government itself.

   (Ga. L. 1941, p. 241, § 10; Ga. L. 1953, Jan.-Feb. Sess., p. 103, § 1; Ga. L. 1955, p. 618, § 2; Code 1933, § 88-1812, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1967, p. 552, § 1; Ga. L. 1968, p. 1098, § 1.)

31-7-85. Contracts with political subdivisions.

1. For the purpose of using such facilities, any city or county is authorized by action of its governing body to enter into contracts with an authority for such periods of time not exceeding 40 years as shall be necessary to provide for the continued maintenance and use of the facilities of an authority. Sums due and payable under such contract shall be determined from year to year during the period of such contract and no sums shall be paid for the services in excess of the amounts necessary to provide for the maintenance and operation of projects of authorities and such sums as shall be necessary to provide adequate and necessary facilities for medical care and hospitalization of the indigent sick, including reasonable reserves necessary for expansion and necessary for the payment of the cost of facilities of the projects, provided that any such contract may obligate a city or county or any combination thereof to pay for such services a fixed and definite minimum sum each year based or calculated upon the anticipated cost of such services including the cost and expense of making the facilities of the authority available for the furnishing and performance of such services. The contracts authorized under this Code section to be entered into between cities or counties or any combination thereof and an authority may provide for the conveyance or lease of any existing hospital facilities or projects to an authority created by any such cities or counties for a nominal consideration only, provided that such conveyance shall contain a clause providing that, upon dissolution of the authority, such hospital facilities or projects shall revert to the city or county conveying the same to the authority and provided, further, that no property so conveyed may be mortgaged or in any way given as security for an indebtedness of the authority; this limitation is not to be construed as limiting the right of the authority to pledge or hypothecate revenues which may be realized by the authority from the operation of any property so conveyed to the authority.
2. When, in accordance with this article, any county shall activate a hospital authority for such county and such authority shall acquire or construct or shall make preparations to acquire or construct a hospital in the county, any municipality in the county shall be authorized to contract with the hospital authority for the care in such hospital of indigent sick or injured persons who are residents of the municipality either on a per-patient-per-day basis or for a fixed amount of money payable at such time as the contracting parties may agree upon; and any such contract may, at the election of such municipality, be binding upon it for a period of not exceeding 40 years. Such contract and the amount to be received by the hospital authority thereunder may be pledged by the hospital authority as security for the payment of the principal and interest of any bonds or revenue anticipation certificates which it may issue in order to acquire or construct the hospital.

   (Ga. L. 1941, p. 241, § 10; Ga. L. 1953, Jan.-Feb. Sess., p. 103, § 1; Ga. L. 1955, p. 618, § 2; Code 1933, § 88-1813, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1964, Ex. Sess., p. 15, § 2.)

31-7-86. Manner of operating property conveyed or leased to authority.

Any property conveyed or leased to an authority by cities or counties shall be operated by the authority to which the same is conveyed, together with other facilities of the authority, in accordance with this article and the resolution of the governing body or bodies or participating units.

(Ga. L. 1941, p. 241, § 10; Ga. L. 1953, Jan.-Feb. Sess., p. 103, § 1; Ga. L. 1955, p. 618, § 2; Code 1933, § 88-1814, enacted by Ga. L. 1964, p. 499, § 1.)

31-7-87. Hypothecation or mortgaging of purchased hospital facilities.

Should an authority acquire by purchase existing hospital facilities of political subdivisions and pay the reasonable value therefor, nothing in this article shall be construed to prevent the hypothecation or mortgaging of such facilities as security for the repayment of any indebtedness which may be legally incurred by such authority.

(Ga. L. 1941, p. 241, § 10; Ga. L. 1953, Jan.-Feb. Sess., p. 103, § 1; Ga. L. 1955, p. 618, § 2; Code 1933, § 88-1815, enacted by Ga. L. 1964, p. 499, § 1.)

31-7-88. Payment of general obligations.

Obligations of an authority other than certificates shall be payable from general funds of an authority and shall at no time be a charge against any special fund allocated to the payment of certificates except upon payment of current annual maturities and reserves required to be created under Code Section 31-7-77. The maturity of any such obligations shall not extend for more than 40 years.

(Ga. L. 1941, p. 241, § 11; Code 1933, § 88-1816, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1974, p. 424, § 1.)

31-7-89. Procedure for dissolution; disposition of property.

By joint action of the board of trustees of an authority and the governing bodies of participating units, authorities created under and pursuant to the terms of this article may be dissolved, provided that no such dissolution shall in any way impair the rights of third persons or the contracts of the authority with such third persons. Disposition to be made of the property of the authority upon dissolution shall be covered in any resolution adopted by the participating units and the board of trustees of the authority. At no time, however, shall any authority upon dissolution convey any of its property, except as may be otherwise authorized by law, to any private person, association, or corporation.

(Ga. L. 1941, p. 241, § 13; Code 1933, § 88-1817, enacted by Ga. L. 1964, p. 499, § 1.)

31-7-89.1. "Control" defined; sale or lease by hospital authority subject to requirements of Article 15 of this chapter.

1. As used in this Code section, the term "control" means ownership of 50 percent or more of the assets of the entity in question or the ability to influence significantly the operations or decisions of the entity in question.
2. The sale or lease of assets of a hospital owned or operated by a hospital authority to an individual, business corporation, general partnership, limited partnership, limited liability company, limited liability partnership, joint venture, nonprofit corporation, hospital authority, or any other for profit or not for profit entity shall be subject to the notice, hearing, certification, enforcement, and other requirements of Article 15 of this chapter which are applicable to dispositions of nonprofit hospitals to acquiring entities if the disposition of assets constitutes a sale or lease of 50 percent or more of the assets of a hospital having a permit under this chapter or constitutes a sale or lease which, when combined with one or more transfers between the same or related parties occurring within a period of five years, constitutes a sale or lease of 50 percent or more of the assets of a hospital having a permit under this chapter; provided, however, that the provisions of this Code section shall not apply to the restructuring of a hospital owned by a hospital authority involving a lease of assets to any not for profit or for profit entity which has a principal place of business located in the same county where the main campus of the hospital in question is located and which is not owned, in whole or in part, or controlled by any other for profit or not for profit entity whose principal place of business is located outside such county.
3. Notwithstanding the provisions of subsection (b) of this Code section, the sale or lease of assets of a hospital owned or operated by a hospital authority to another hospital authority whose area of operation is a county contiguous to the county in which is located the hospital whose sale or lease is proposed shall not be subject to the requirements of Article 15 of this chapter.
4. Notwithstanding any other provision of this article to the contrary, a hospital authority which is located in a county having a population of 50,000 or fewer, according to the United States decennial census of 1990 or any future such census, may locate a project outside that hospital authority's area of operation if such location is in a county which is contiguous to the county of such hospital authority's area of operation. (Code 1981, § 31-7-89.1 , enacted by Ga. L. 1997, p. 1091, § 2; Ga. L. 1999, p. 850, § 3.1.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1997, "this chapter" was substituted for "Chapter 7 of Title 31" in subsection (b).

31-7-90. Annual report; budget.

The board of trustees of each authority created under this article shall file with the governing body or bodies of political subdivisions or participating units, on forms prescribed by the department, an annual report of the activities of the authority and shall annually consider and adopt as a part of such report a budget, which budget shall be filed with the annual report. The board of trustees may hold a public hearing on the budget, and representatives of any governing body within the area of operation of the authority or any other person having an interest in such budget shall have the right to be heard with respect to any matter covered by the report of the board of trustees or by the budget.

(Ga. L. 1941, p. 241, § 14; Code 1933, § 88-1818, enacted by Ga. L. 1964, p. 499, § 1.)

31-7-90.1. Community benefit report; report disclosing member ownership in entities transacting business with authority.

1. Each hospital authority created by and under this article shall annually prepare a community benefit report disclosing the cost of indigent and charity care provided by such authority for the preceding year not later than 90 days after the close of the fiscal or calendar year. Such report provided for in this Code section shall include a statement of the cost and type of indigent and charity care provided by the authority, including the number of indigent persons served, categorization of those persons by county of residence, as well as the cost of indigent and charity care provided in dollars. Such community benefit report shall be filed with the clerk of superior court of the county in which the authority's hospital is located, as well as with the governing body or bodies of such authority's participating units.
2. Each hospital authority created by and under this article shall also annually prepare a report indicating any entity in which a member or member's family has a direct or indirect ownership of assets or stock constituting between 10 percent and 25 percent which transacted business with the authority during the previous year. Such report shall be filed with the clerk of superior court of the county in which the authority's hospital is located, as well as with the governing body or bodies of such authority's participating units. (Code 1981, § 31-7-90.1 , enacted by Ga. L. 1997, p. 1404, § 4.)

Law reviews. - For article, "Putting the Community Back into the 'Community Benefit' Standard," see 44 Ga. L. Rev. 375 (2010).

31-7-91. Required annual audit.

Each hospital authority created by and under this article shall ensure that an annual audit of the financial affairs, books, and records of such authority is conducted at the end of each fiscal year for the preceding year. Each hospital authority shall obtain either a certified public accountant or a firm of certified public accountants to conduct such audit. The auditor so appointed shall perform the audit in accordance with generally accepted accounting principles and shall submit a complete and final report and audit to the authority not later than 90 days after the close of the fiscal year. All audits provided for in this Code section shall be certified to and shall include, but in no way be limited to, a full and complete audit containing a balance sheet, profit and loss statement, and statement of receipts and disbursements.

(Code 1933, § 88-1821, enacted by Ga. L. 1964, p. 499, § 1.)

31-7-92. Filing of audits.

All final audits provided for in Code Section 31-7-91 shall be reproduced in sufficient number and copies of the audit shall be filed with the clerk of the superior court in the county where any hospital is operated by a hospital authority and in the office of the clerk of the superior court of any county that is a participating unit of the authority. In the event any hospital is operated by a municipal hospital authority, the audit required by this Code section to be filed with the office of the clerk of the superior court shall be filed in the office of city clerk, clerk of council, clerk of the board of aldermen, or clerk of the governing body of the municipality, in lieu of being filed with the clerk of the superior court.

(Code 1933, § 88-1822, enacted by Ga. L. 1964, p. 499, § 1; Ga. L. 1986, p. 489, § 1; Ga. L. 1991, p. 94, § 31.)

31-7-93. Failure to provide for audit.

In the event any hospital authority shall fail or refuse to provide for an annual audit and have such audit prepared and filed as set forth in Code Sections 31-7-91 and 31-7-92, any taxpayer of any participating unit of such authority or the governing authority of such unit may petition the superior court of the county wherein the authority operates a hospital to require the authority to have such audit prepared and filed as provided by the above Code sections. The judge of such court shall set a time for the hearing on such petition and after notice to the authority shall hear and determine the petition. If it is determined that the authority has failed to comply with the requirements for the preparation and filing of the audit, the judge shall pass such orders as are necessary to effectuate compliance with such requirements. In the event the authority fails to have an audit prepared and filed as required by court order, the members of the authority shall be subject to contempt proceedings by the court as provided by law.

(Code 1933, § 88-1823, enacted by Ga. L. 1964, p. 499, § 1.)

31-7-94. Grants to hospital authorities and rural hospital organizations.

The state is authorized to make grants, as funds are available, to hospital authorities and rural hospital organizations for public health purposes, provided that any funds so granted shall be distributed to and among the various public hospital authorities and rural hospital organizations in the state in proportion to the number of hospital beds operated by each such hospital authority or rural hospital organization at the end of the calendar year preceding the grant. Funds shall be distributed to public hospitals and rural hospital organizations operated by consolidated governments in the same manner as to authority hospitals prescribed in this Code section and rural hospital organizations. Grants made by the state pursuant to this Code section shall be administered by the Department of Community Health in accordance with Code Section 31-7-94.1 and such rules, regulations, and procedures as it shall deem necessary for effective administration of such grants.

(Code 1933, § 88-1824, enacted by Ga. L. 1975, p. 777, § 1; Ga. L. 1985, p. 149, § 31; Ga. L. 2002, p. 1132, § 2; Ga. L. 2017, p. 411, § 1/SB 14.)

The 2017 amendment, effective May 8, 2017, throughout this Code section, inserted "and rural hospital organizations"; inserted "or rural hospital organization" near the end of the first sentence; and inserted "Code Section 31-7-94.1 and" in the middle of the third sentence.

31-7-94.1. Rural Hospital Organization Assistance Act; legislative findings; certification of rural hospitals for grant eligibility; rules and regulations.

1. This Code section shall be known and may be cited as the "Rural Hospital Organization Assistance Act of 2017."
2. The General Assembly finds that hospital authorities and rural hospital organizations are essential in order to promote public health goals of the state. The General Assembly further finds that many rural hospital organizations are in desperate financial straits. In order to preserve the availability of primary health care services provided by such hospitals to residents of rural counties, the General Assembly has determined that a program of state grants is necessary and recommends funds be made available to such hospitals. These grants will be conditioned upon those hospitals continuing to furnish essential health care services to residents in their areas of operation as well as engaging in the long-range planning and any restructuring which may be required for those hospitals to survive by devising cost-effective and efficient health care systems for meeting local health care needs.
3. As used in this Code section, the term:
   1. "Hospital" means an institution which has a permit as a hospital issued under this chapter.
   2. "Rural county" means a county having a population of less than 50,000 according to the United States decennial census of 2010 or any future such census; provided, however, that for counties which contain a military base or installation, the military personnel and their dependents living in such county shall be excluded from the total population of such county for purposes of this definition.
   3. "Rural hospital organization" means an acute care hospital licensed by the department pursuant to Article 1 of this chapter that:
      1. Provides inpatient hospital services at a facility located in a rural county or is a critical access hospital;
      2. Participates in both Medicaid and medicare and accepts both Medicaid and medicare patients;
      3. Provides health care services to indigent patients;
      4. Has at least 10 percent of its annual net revenue categorized as indigent care, charity care, or bad debt;
      5. Annually files IRS Form 990, Return of Organization Exempt From Income Tax, with the department, or for any hospital not required to file IRS Form 990, the department will provide a form that collects the same information to be submitted to the department on an annual basis;
      6. Is operated by a county or municipal authority pursuant to this article or is designated as a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code; and
      7. Is current with all audits and reports required by law.
4. A rural hospital organization may apply for a grant available under subsection (e) of this Code section if it has been certified by the department as:
   1. A rural hospital organization; and
   2. Having submitted a grant application which includes:
      1. A problem statement indicating the problem the rural hospital organization proposes to solve with the grant funds;
      2. The goals of the proposed solution;
      3. The organizational structure, financial system, and facilities that are essential to the proposed solution;
      4. The projected longevity of the proposed solution after the grant funds are expended;
      5. Evidence of collaboration with other community health care providers in achieving the proposed solution;
      6. Evidence that funds for the proposed solution are not available from another source;
      7. Evidence that the grant funds would assist in returning the rural hospital organization to an economically stable condition or that any plan for closure or realignment of services involves development of innovative alternatives for the discontinued services;
      8. Evidence of a satisfactory record-keeping system to account for grant fund expenditures within the rural hospital organization and the rural county;
      9. A community health survival plan describing how the plan was developed, the goals of the plan, the links with existing health care providers under the plan, the implementation process including quantification of indicators of the hospital's financial well-being, measurable outcome targets, and the current condition of such hospital; and
      10. Such additional evidence as the department may require to demonstrate the feasibility of the proposed solution for which grant funds are sought.
5. The department is authorized to make grants to rural hospital organizations certified as meeting the requirements of subsection (d) of this Code section. Grants to rural hospitals owned or operated by hospital authorities or rural hospital organizations may be for any of the following purposes:
   1. Infrastructure development, including, without being limited to, health information technology, facility renovation, or equipment acquisition; provided, however, that the amount granted to any qualified hospital may not exceed the expenditure thresholds that would constitute a new institutional health service requiring a certificate of need under Chapter 6 of this title and the grant award may be conditioned upon obtaining local matching funds;
   2. Strategic planning, including, without being limited to, strategies for personnel retention or recruitment, development of an emergency medical network, or the development of a collaborative and integrated health care delivery system with other health care providers, and the grant award may be conditioned upon obtaining local matching funds for items such as telemedicine, billing systems, and medical records. For the purposes of this paragraph, the maximum grant to any grantee shall be $500,000.00;
   3. Nontraditional health care delivery systems, excluding operational funds and purposes for which grants may be made under paragraph (1) or (2) of this subsection. For the purposes of this paragraph, the maximum grant to any grantee shall be $2.5 million; or
   4. The provision of 24 hour emergency room services open to the general public.
6. In awarding grants under this Code section, the department may give priority to any otherwise eligible rural hospital organization which meets the definition of a necessary provider as specified in the state's "Rural Healthcare Plan" of May, 1998.
7. The maximum grant to any hospital authority or rural hospital organization shall be $4 million per calendar year.
8. The department shall be authorized to certify rural hospital organizations as provided in subsection (d) of this Code section and shall adopt regulations to implement its powers and duties under this Code section. (Code 1981, § 31-7-94.1 , enacted by Ga. L. 2017, p. 411, § 2/SB 14; Ga. L. 2018, p. 1112, § 31/SB 365.)

Effective date. - This Code section became effective May 8, 2017.

The 2018 amendment, effective May 8, 2018, part of an Act to revise, modernize, and correct the Code, substituted "Having" for "Has" at the beginning of paragraph (d)(2).

Editor's notes. - This Code section formerly pertained to the Rural Hospital Assistance Act. The former Code section was based on Code 1981, § 31-7-94.1 , enacted by Ga. L. 1999, p. 469, § 1; Ga. L. 2000, p. 136, § 31; Ga. L. 2002, p. 1132, § 3; Ga. L. 2006, p. 152, § 2D/HB 1178; Ga. L. 2009, p. 453, § 1-8/HB 228 and was repealed by Ga. L. 2017, p. 411, § 2/SB 14, effective May 8, 2017.

31-7-95. Funding of medical education provided by hospital authorities and designated teaching hospitals.

1. As used in this Code section, the term:
   1. "Designated teaching hospital" means a teaching hospital operated by other than a hospital authority, which hospital agrees to contract with the state to offer or continue to offer a residency program approved by the American Medical Association, which program has at least 50 residents and which hospital operates a 24 hour, seven-day-per-week emergency room open to the public and which hospital files a semiannual statistical report consistent with those filed by other state funded tertiary, neonatal, obstetrical centers with the Department of Community Health.
   2. "Hospital authority" means a hospital authority operating a teaching hospital which offers a residency program approved by the American Medical Association.
   3. "Resident" means a physician receiving medical education and training through a teaching hospital operated by a hospital authority or designated teaching hospital.
2. The General Assembly finds that the major hospital authorities and designated teaching hospitals in this state provide a valuable service benefiting the entire state by operating teaching hospitals which provide necessary medical education and training for physicians; this service is provided through residency programs offered by these teaching hospitals. By the provision of residency programs operated by state teaching hospitals, the state has recognized its responsibility to fund the cost of training physicians; and it is the purpose of this Code section to recognize that the state has a similar responsibility when the medical education and training are provided by teaching hospitals operated by hospital authorities or by designated teaching hospitals.
3. For each resident receiving medical education and training through a teaching hospital operated by a hospital authority or designated teaching hospital, the Department of Community Health shall pay no more than $10,000.00 per annum to the hospital authority or designated teaching hospital. Such payments shall be made based upon certifications by the hospital authorities or designated teaching hospitals to the Department of Community Health. The Department of Community Health is authorized to designate the Georgia Board of Health Care Workforce to promulgate rules and regulations specifying procedures for making the certifications provided for in this Code section and to establish a procedure for making payments to hospital authorities and designated teaching hospitals as provided in this Code section.
4. The funds necessary to carry out this Code section shall derive from funds appropriated for such purpose to the Department of Community Health. In the event the funds appropriated by the General Assembly are insufficient to fund the full amount payable to hospital authorities or designated teaching hospitals under subsection (c) of this Code section, the amount otherwise payable thereunder shall be reduced pro rata in accordance with the funds actually appropriated for such purpose. The Department of Community Health shall have the authority to promulgate rules and regulations to carry out the provisions of this Code section. No additional teaching hospitals will be added until such funds have been made available for any additional teaching hospitals.
5. Nothing in this Code section shall be construed to amend, modify, supersede, or repeal Chapter 10 of Title 49.

   (Code 1933, § 88-1825, enacted by Ga. L. 1980, p. 1040, § 1; Ga. L. 1984, p. 585, § 2; Ga. L. 1991, p. 94, § 31; Ga. L. 1998, p. 193, § 1; Ga. L. 2000, p. 1421, § 1; Ga. L. 2009, p. 453, § 1-29/HB 228; Ga. L. 2019, p. 224, § 2/SB 207.)

The 2019 amendment, effective July 1, 2019, substituted "Georgia Board of Health Care Workforce" for "Georgia Board for Physician Workforce" in the third sentence of subsection (c).

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1985, paragraphs (a)(.1), (a)(1), and (a)(2) were redesignated as paragraphs (a)(1), (a)(2), and (a)(3); a hyphen was deleted between "state" and "funded" in the present paragraph (a)(1); and "hospital" was substituted for "hospitals" in the last sentence of subsection (c).

Pursuant to Code Section 28-9-5, in 1998, the name of the Joint Advisory Board of Family Practice was changed to the Georgia Board for Physician Workforce in the second sentence sentence of subsection (c).

Administrative Rules and Regulations. - Residency Capitation, Official Compilation of the Rules and Regulations of the State of Georgia, Georgia Board for Physician Workforce, Chapter 195-2.

31-7-96. Construction of article.

This article, being necessary for the welfare of the citizens of the state, shall be liberally construed to effect the purposes hereof; and insofar as this article may be inconsistent with any other law, whether by charter of any political subdivision of the state or otherwise, this article shall be controlling.

(Ga. L. 1941, p. 241, § 16; Code 1933, § 88-1819, enacted by Ga. L. 1964, p. 499, § 1.)

Cross references. - Revenue bonds generally, § 36-82-60 et seq.

31-7-110. Short title.

This article shall be known and may be cited as the "Residential Care Facilities for the Elderly Authorities Act."

(Ga. L. 1980, p. 1466, § 1.)

31-7-111. Findings; declaration of policy.

1. It is found, determined, and declared that:
   1. There exists in this state a seriously inadequate supply of and a critical need for facilities which can furnish the comprehensive services required by elderly persons in a single location, including, without limitation, residential care and the types of services provided in skilled nursing homes, intermediate care homes, assisted living communities, and personal care homes (hereinafter referred to as "residential care facilities for the elderly");
   2. The aforesaid shortage of residential care facilities for the elderly is threatening to the safety, health, convenience, and welfare of certain elderly citizens; and
   3. An adequate supply of residential care facilities for the elderly to provide the special facilities and services needed by elderly persons cannot be provided through the ordinary operation of private enterprise, and therefore the involvement of a public agency, as is contemplated in this article, in such an undertaking would not be competitive with private enterprise.

      Accordingly, it is determined that it is a valid public purpose, as a matter of public health, safety, convenience, and welfare, to assist in providing residential care facilities for the elderly.

2. It is further found and declared that the creation of the authorities, as provided in this article, in the cities and counties of this state and the carrying out by such authorities of the corporate powers conferred in this article in connection with providing an adequate supply of residential care facilities for the elderly are in all respects for the benefit of the people of this state and a public purpose within the meaning of the Constitution of Georgia in that:
   1. Providing an adequate supply of residential care facilities for the elderly for the people of this state is necessary to the public health and welfare; and
   2. The development and stimulation of trade and commerce in this state is vital to the public welfare, creates employment opportunities, and lessens unemployment and underemployment.

      (Ga. L. 1980, p. 1466, § 2; Ga. L. 2011, p. 227, § 14/SB 178.)

31-7-112. Definitions.

As used in this article, the term:

1. "Authority" means each public corporation created pursuant to this article.
2. "Cost of project" includes:
   1. All costs of construction, purchase, or other form of acquisition;
   2. All costs of real or personal property required for the purposes of the project and of all facilities related thereto and the cost of extinguishing any liens or security interests related to the property so acquired, including land and any rights or undivided interest therein; easements, franchises, water rights, fees, permits, approvals, licenses, and certificates; the securing of such franchises, permits, approvals, licenses, and certificates; and the preparation of applications therefor;
   3. Costs of all machinery, equipment, initial fuel, and other supplies required for the project;
   4. Financing charges, interest prior to and during construction and for six months thereafter;
   5. Costs of engineering, architectural, and legal services;
   6. Fees paid to fiscal agents for financial and other advice or supervision;
   7. Costs of plans and specifications and all expenses necessary or incidental to the construction, purchase, or acquisition of the project or to determining the feasibility or practicability of the project; and
   8. Administrative expenses and such other expenses as may be necessary or incidental to the financing authorized in this article.

      There may also be included, as part of the cost of a project, the repayment of any loans made for the advance payment of any part of such cost, including interest thereon at rates to be determined by the authority, which loans are authorized if made payable solely from the proceeds of the authority's bonds or notes or revenues to be received in connection with the leasing, sale, or financing of the project. The cost of a project may also include a fund or funds for the creation of a debt service reserve, a renewal and replacement reserve, and such other reserves as may be reasonably required by the authority with respect to the financing and operation of any project and as may be authorized by any bond resolution or trust agreement or indenture pursuant to the provisions of which the issuance of any such bonds may be authorized. Any obligation or expense incurred for any of the foregoing purposes shall be paid or reimbursed as a part of the cost of the project out of the proceeds of revenue bonds or notes issued under this article.

3. "County" means any county of this state.
4. "Eligible persons" means persons who have reached the age of 62 years and who have need for housing which provides the special facilities and services required by elderly persons and who meet the criteria for eligibility set forth in rules and regulations which are from time to time promulgated by the authority pursuant to the grant of authority so to do which is contained in subsection (b) of Code Section 31-7-114.
5. "Governing body" means the elected or duly appointed officials constituting the governing body of each municipal corporation and county in this state.
6. "Municipal corporation" means each city and town in this state.
7. "Project" or "residential care facility for the elderly" means:
   1. Any one or more buildings or structures to be used in providing at a single location the comprehensive services required by the elderly, including, without limitation, residential care and the types of services provided in skilled nursing homes, intermediate care homes, assisted living communities, and personal care homes supplied with all necessary or useful furnishings, machinery, equipment, parking facilities, landscaping, and facilities for outdoor storage, all as determined by the authority, which determination shall be final and not subject to review; provided, however, that no single project or residential care facility shall be required to render all types of services and levels of care referred to above. There may be included as part of any such project all improvements necessary to the full utilization thereof, including, without limitation, site preparation; roads and streets; sidewalks; water supply; outdoor lighting; belt line railroad; railroad sidings and lead tracks; bridges; causeways; terminals for railroad, automotive, and air transportation; transportation facilities incidental to the project; and the dredging and improving of harbors and waterways. However, none of the aforementioned improvements shall be the primary purpose of any project;
   2. The acquisition, construction, leasing, or equipping of new residential care facilities for the elderly or the improvement, modification, acquisition, expansion, modernization, leasing, equipping, or remodeling of existing residential care facilities for the elderly located or to be located within the area of operation of the authority; and
   3. The acquisition, construction, improvement, or modification of any property, real or personal, which any qualified sponsor might desire to use, acquire, or lease in connection with the operation of any project located or to be located within the area of operation of the authority.
8. "Qualified sponsor" means any nonprofit corporation which has met criteria established by the authority and which has undertaken to provide residential care facilities for the elderly which will be available for sale or rent to eligible persons.

   (Ga. L. 1980, p. 1466, § 3; Ga. L. 2011, p. 227, § 15/SB 178.)

31-7-113. Creation of Residential Care Facilities for the Elderly Authority in each county and municipality; board of directors.

1. There is created in and for each county and municipal corporation in this state a public body corporate and politic to be known as the "Residential Care Facilities for the Elderly Authority" of such county or municipal corporation.
2. Each authority shall consist of a board of seven directors to be appointed by resolution of the governing body of such county or municipal corporation for initial terms of two, four, and six years and thereafter for staggered terms of six years. The governing body of the municipality or county shall initially elect two directors for two years, two directors for four years, and three directors for six years; and thereafter the terms of all directors shall be six years. If at the end of any term of office of any director a successor thereto shall not have been elected, the director whose term of office shall have expired shall continue to hold office until his successor shall be so elected. A majority of the directors shall constitute a quorum but no action may be taken by the board without the affirmative vote of a majority of the full membership of the board.
3. The directors shall be taxpayers residing in the county or municipal corporation for which the authority is created, and their successors shall be appointed as provided by the resolution described in subsection (b) of this Code section. No director shall be an officer or employee of the county or municipal corporation. The directors shall elect one of their number as chairman and another as vice-chairman and shall also elect a secretary and a treasurer or a secretary-treasurer, any of whom may but need not be a director. The directors shall receive no compensation for their services but shall be reimbursed for their actual expenses incurred in the performance of their duties.
4. No authority shall transact any business or exercise any powers under this article until the governing body of the county or municipal corporation shall, by proper resolution, declare that there is a need for an authority to function in such county or municipal corporation. A copy of the resolution shall be filed with the Secretary of State, who shall maintain a record of all authorities activated under this article.
5. The authority may make bylaws and regulations for its governance and may delegate to one or more of its officers, agents, and employees such powers and duties as may be deemed necessary and proper. The authority shall have perpetual existence.

   (Ga. L. 1980, p. 1466, §§ 4, 5.)

31-7-114. Powers of authorities.

1. Each authority shall have all of the powers necessary or convenient to carry out and effectuate the purposes and provisions of this article, including, but without limiting the generality of the foregoing, the power:
   1. To bring and defend an action;
   2. To adopt and amend a corporate seal;
   3. To make and execute contracts and other instruments necessary to exercise the powers of the authority, any of which contracts may be made with the county in which the authority is located or with any one or more municipal corporations in such county; and each such county and all municipal corporations therein are authorized to enter into contracts with each authority;
   4. To receive and administer gifts, grants, and devises of any property and to administer trusts;
   5. To acquire by purchase, gift, or construction any real or personal property desired to be acquired by the authorities as part of any project or for the purpose of improving, extending, adding to, reconstructing, renovating, or remodeling any project or part thereof already acquired, or for the purpose of demolition to make room for such project or any part thereof;
   6. To purchase, sell, lease, exchange, transfer, assign, pledge, mortgage, or dispose of, or grant options for any such purposes, any real or personal property or interest therein;
   7. To mortgage, convey, pledge, or assign any properties, revenues, income, tolls, charges, or fees owned, received, or to be received by the authority;

      (7.1) To invest and reinvest the funds of the authority in any investment which a domestic insurer may lawfully invest in, to determine the allocation of funds among investments, and to purchase, hold, sell, assign, transfer, and dispose of any securities and other investments in which funds of the authority have been invested, any proceeds of any investments, and any money belonging to the authority;

      (7.2) To provide grants, scholarships, loans, or other assistance to students pursuing a course of study relating to gerontology with particular emphasis on residential care and housing facilities for the elderly, subject to such bylaws and regulations as may be made by the authority;

   8. To appoint officers and retain agents, engineers, attorneys, fiscal agents, accountants, and employees and to provide for their compensation and duties;
   9. To extend credit or make loans to any qualified sponsor for the planning, design, construction, acquisition, or carrying out of any project, which credit or loans shall be secured by loan agreements, mortgages, security agreements, contracts, and all other instruments or fees or charges, upon such terms and conditions as the authority shall determine to be reasonable, including provision for the establishment and maintenance of reserves and insurance funds; and, in the exercise of powers granted by this Code section in connection with a project for a qualified sponsor, to require the inclusion in any contract, loan agreement, security agreement, or other instrument such provisions for guaranty, insurance, construction, use, operation, maintenance, and financing of the project as the authority may deem necessary or desirable;
   10. To acquire, accept, or retain equitable interests, security interests, or other interest in any property, real or personal, by mortgage, assignment, security agreement, pledge, conveyance, contract, lien, loan agreement, or other consensual transfer in order to secure the repayment of any moneys loaned or credit extended by the authority;
   11. To construct, acquire, own, repair, remodel, maintain, extend, improve, and equip projects located on land owned or leased by the authority or land owned or leased by others and to pay all or part of the cost of any such project from the proceeds of revenue bonds of the authority or from any contribution or loans by a qualified sponsor, all of which the authority is authorized to receive, accept, and use;
   12. To borrow money and to issue its revenue bonds and bond anticipation notes from time to time and use the proceeds thereof for the purpose of paying all or part of the cost of any project, including the cost of extending, adding to, or improving such project or for the purpose of refunding or refinancing any such bonds of the authority theretofore issued or any other outstanding obligations of the authority; and otherwise to carry out the purposes of this article and to pay all other costs of the authority incident to, or necessary and appropriate to, such purposes, including the provision of moneys to be paid into any fund or funds to secure such bonds and notes; provided, however, that all such bonds and notes shall be issued in accordance with the procedures and subject to the limitations set forth in subsections (a) through (h) of Code Section 31-7-116;
   13. To pledge, mortgage, convey, assign, hypothecate, or otherwise encumber any property, real or personal, of the authority as security for repayment of authority obligations and to execute any trust agreement, indenture, or security agreement containing any provisions not in conflict with law, which trust agreement, indenture, or security agreement may provide for foreclosure or forced sale of any property of the authority upon default on such obligations either in payment of principal or interest or in the performance of any term or condition contained in the agreement or indenture. The state on behalf of itself and each county, municipal corporation, political subdivision, or taxing district therein waives any right that it or such county, municipal corporation, political subdivision, or taxing district may have to prevent the forced sale or foreclosure of any property of the authority so mortgaged or encumbered; and any such mortgage or encumbrance may be foreclosed in accordance with law and the terms thereof; and
   14. To do all things necessary or convenient to carry out the powers expressly conferred by this article.
2. The authority shall adopt and promulgate rules and regulations which establish and prescribe criteria for determining eligible persons and qualified sponsors for the purposes of this article.

   (Ga. L. 1980, p. 1466, § 6; Ga. L. 1985, p. 149, § 31; Ga. L. 1997, p. 1501, § 1.)

31-7-115. Lease or sale of projects.

No project acquired under this article shall be operated by an authority, any municipal corporation, county, or other governmental subdivision; but such projects shall be leased or sold to one or more qualified sponsors. If revenue bonds or other obligations are to be issued to pay all or part of the cost of such project, the project must be so leased or the contract for its sale entered into prior to or simultaneously with the issuance of such bonds or obligations unless the proceeds of the revenue bonds or other obligations are to be loaned to a qualified sponsor in connection with the development of a project, in which case an appropriate loan agreement shall be entered into prior to or simultaneously with the issuance of such bonds or obligations. If the project is sold, the purchase price may be paid at one time or in installments falling due over not more than 40 years from the date of transfer of possession. The lessee or purchaser shall be required to pay all costs of operating and maintaining the leased or purchased property and to pay rentals or installments in amounts sufficient to pay the principal of and interest and premium, if any, on all of its bonds and other obligations as the principal and interest become due.

(Ga. L. 1980, p. 1466, § 7.)

31-7-116. Provisions contained in obligations and security for obligations; procedures for issuance of bonds and bond anticipation notes; interest rates; limitations and conditions.

1. The obligations of any authority evidenced by bonds, bond anticipation notes, trust indentures, deeds to secure obligations, security agreements, or mortgages executed in connection therewith may contain such provisions not inconsistent with law as shall be determined by the board of directors of the authority. Such instruments may provide for the pledging of all or any part of the revenues of the authority and for the mortgaging, encumbering, or conveying of all or any part of its real or personal property; may covenant against pledging any or all of its revenues, income, or charges; and may further provide for the disposition of proceeds realized from the sale of any bonds and bond anticipation notes, for the replacement of lost, destroyed, stolen, or mutilated bonds and notes and for the payment and redemption of such bonds and notes. Undertakings of an authority may prescribe the procedure by which bondholders and noteholders may enforce rights against the authority and may provide for rights upon breach of any covenant, condition, or obligation of the authority. Bonds, resolutions, trust indentures, mortgages, or deeds to secure obligations executed by an authority and bond anticipation notes executed by an authority may contain such provisions not otherwise contrary to law as the authority shall deem necessary or desirable.
2. The proceeds derived from the sale of any bonds or bond anticipation notes issued by an authority shall be held and used for the ultimate purpose of paying, directly or indirectly as permitted in this article, all or part of the cost of any project or for the purpose of refunding any bond anticipation notes issued in accordance with this article or refunding any previously issued bonds of the authority.
3. All bonds and bond anticipation notes issued by an authority shall be revenue obligations of such authority and may be made payable out of any revenues or other receipts, funds, or moneys of the authority, subject only to any agreements with the holders of other bonds or bond anticipation notes or to particular security agreements pledging any particular revenues, receipts, funds, moneys, or other property.
4. Issuance by any authority of one or more series of bonds or bond anticipation notes for one or more purposes shall not preclude the authority from issuing other bonds or notes in connection with the same project or in connection with any other projects; provided, however, that the proceeding wherein any subsequent bonds or bond anticipation notes shall be issued shall recognize and protect any prior pledge or mortgage made in any prior security agreement or made for any prior issue of bonds or bond anticipation notes unless, in the resolution authorizing such prior issue, the right is expressly reserved to the authority to issue subsequent bonds or bond anticipation notes on a parity with such prior issue.
5. An authority shall have the power and is authorized, whenever revenue bonds of the authority shall have been validated as provided in this article, to issue from time to time its notes in anticipation of the issuance of such bonds as validated and to renew from time to time any such notes by the issuance of new notes, whether the notes to be renewed have or have not matured. The authority may issue notes only to provide funds which would otherwise be provided by the issuance of the bonds as validated. The notes may be authorized, sold, executed, and delivered in the same manner as bonds. As with its bonds, an authority may sell such notes at public or private sale. Any resolution or resolutions authorizing notes of an authority or any issue thereof may contain any provisions which an authority is authorized to include in any resolution or resolutions authorizing bonds of an authority or any issue thereof, and an authority may include in any notes any terms, covenants, or conditions which it is authorized to include in any bonds. Validation of such bonds shall be a condition precedent to the issuance of such notes, but it shall not be required that such notes be judicially validated. Bond anticipation notes shall not be issued in an amount exceeding the par value of the bonds in anticipation of which they are to be issued.
6. The interest rate on or rates to be borne by any bonds, notes, or obligations issued by the authority shall be fixed by the board of directors of the authority and any limitations with respect to interest rates found in Article 3 of Chapter 82 of Title 36 or in the usury laws of this state shall not apply to obligations issued under this article.
7. All revenue bonds issued by an authority under this article shall be issued and validated under and in accordance with the procedure therefor set forth in Article 3 of Chapter 82 of Title 36, as heretofore and hereafter amended, except as specifically set forth in this subsection:
   1. Revenue bonds issued by an authority may be in such form, either coupon or fully registered, or both coupon and fully registered, and may be subject to such exchangeability and transferability provisions as the bond resolution authorizing the issuance of such bonds or any indenture or trust agreement may provide;
   2. The signature of the clerk of the superior court in which any bonds are validated on the certificate of validation of such bonds may be affixed by facsimile or by manual execution; such entry shall be original evidence of the fact of the validation of any bond and shall be received as original evidence in any court in this state;
   3. In lieu of specifying the rate or rates of interest which revenue bonds to be issued by an authority are to bear, the notice to the district attorney or the Attorney General and the notice to the public of the time, place, and date of the validation hearing may state that the bonds when issued will bear interest at a rate not exceeding a maximum per annum rate of interest specified in such notices or, in the event the bonds are to bear different rates of interest for different maturity dates, that none of such rates will exceed the maximum rate specified in the notices. Nothing contained in this paragraph shall be construed as prohibiting or restricting the right of the authority to sell such bonds at a discount, even if in so doing the effective interest cost resulting therefrom would exceed the maximum per annum interest rate specified in such notices; and
   4. The term "cost of project" shall have the meaning prescribed in paragraph (2) of Code Section 31-7-112 whenever referred to in bond resolutions of an authority, bonds and bond anticipation notes issued by an authority, or notices and proceedings to validate such bonds.
8. Before issuing any bonds to finance any project, the authority shall obtain from the qualified sponsor of the project an undertaking that only eligible persons will be permitted to use or acquire any of the facilities constituting a part of the project or to enjoy or benefit from any of the services to be rendered in connection with any such project.
9. No bonds or bond anticipation notes except refunding bonds shall be issued by an authority under this article unless its board of directors shall adopt a resolution finding that the project for which such bonds or notes are to be issued will promote the objectives stated in subsection (b) of Code Section 31-7-111 and will increase or maintain employment in the territorial area of such authority. Nothing contained in this Code section shall be construed as permitting any authority created under this article or any qualified sponsor to finance, construct, or operate any project without obtaining any certificate of need or other approval, permit, or license which, under the laws of this state, is required in connection therewith.

   (Ga. L. 1980, p. 1466, §§ 8, 9.)

Cross references. - Revenue bonds generally, § 36-82-60 et seq.

31-7-117. Liability for bonds or other obligations.

No bonds or other obligations of and no indebtedness incurred by any authority shall constitute an indebtedness or obligation of the state or any county, municipal corporation, or political subdivision thereof; nor shall any act of any authority in any manner constitute or result in the creation of an indebtedness of the state or any such county, municipal corporation, or political subdivision. All such bonds and obligations shall be payable solely from the revenues therein pledged to such payment, including pledged rentals, sales proceeds, insurance proceeds, and condemnation awards. No holder or holders of any such bonds or obligations shall ever have the right to compel any exercise of the taxing power of the state or any county, municipal corporation, or political subdivision thereof nor to enforce the payment thereof against any property of the state or any such county, municipal corporation, or political subdivision.

(Ga. L. 1980, p. 1466, § 11.)

31-7-118. Exemption from taxation.

1. Each authority created under this article is created for nonprofit and public purposes, and it is found, determined, and declared that:
   1. The creation of each such authority and the carrying out of its corporate purposes are in all respects for the benefit of the people of this state;
   2. The authority is an institution of purely public charity and will be performing an essential governmental function in the exercise of the powers conferred upon it by this article; and for such reasons, the state covenants with the holders of the bonds issued under this article that the authority shall be required to pay no taxes or assessments imposed by the state or any of its counties, municipal corporations, political subdivisions, or taxing districts upon any property acquired by the authority or under its jurisdiction, control, possession, or supervision or leased by it to others or upon its activities in the operation or maintenance of any such property or on any income derived by the authority in the form of fees, recording fees, rentals, charges, purchase price, installments, or otherwise; and
   3. The bonds of the authority, their transfer, and the income derived therefrom shall at all times be exempt from taxation within the state.
2. The tax exemption provided in this Code section shall not include any exemption from sales and use tax on property purchased by the authority or for use by the authority.

   (Ga. L. 1980, p. 1466, § 12; Ga. L. 1985, p. 149, § 31.)

31-7-119. Holding moneys as trust funds; pledges for payment of bonds.

1. All moneys received pursuant to the authority of this article, whether as proceeds from the sale of revenue bonds or other obligations, as grants or other contributions, or as revenues and earnings, shall be deemed to be trust funds to be held and applied solely as provided in this Code section. In the resolution providing for the issuance of revenue bonds or in the trust indenture, the authority shall provide for the payment of the proceeds of the sale of the bonds, earnings, and revenues to be received to any officer who, or any agency, bank, or trust company which, shall act as trustee of such funds and shall hold and apply the same to the purposes of this article, subject to the provisions of this article and the provisions of any such resolution or any trust indenture.
2. The authority may pledge for the payment of its bonds such assets, funds, and properties as the resolution providing for the issuance of its bonds may provide. Any such pledge made by the authority shall be valid and binding from the time when the pledge is made; the moneys or properties so pledged and thereafter received by the authority shall immediately be subject to the lien of such pledge without any physical delivery thereof or further act; and the lien of any such pledge shall be valid and binding as against all parties having claims of any kind against the authority, irrespective of whether such parties have notice thereof. No resolution or any other instrument by which a pledge is created need be recorded.

   (Ga. L. 1980, p. 1466, § 13.)

31-7-120. Construction of article.

This article shall be liberally construed to effect the purposes hereof, and insofar as this article may be inconsistent with any other law, including the charter of any municipal corporation, this article shall be controlling. The sale or issuance of bonds by any authority shall not be subject to regulation under Chapter 5 of Title 10 or any other law. No proceeding or publication not required by this article shall be necessary to the performance of any act authorized in this article, nor shall any such act be subject to referendum.

(Ga. L. 1980, p. 1466, § 10; Ga. L. 1985, p. 149, § 31.)

31-7-130. Legislative intent.

It is the intent of the General Assembly to provide protection for those individuals who are members of peer review groups which evaluate the quality and efficiency of professional health care providers and to protect the confidentiality of their records.

(Code 1933, § 84-7601, enacted by Ga. L. 1980, p. 1282, § 1.)

Law reviews. - For article, "The Shield Remains: An Overview of the Georgia Peer Review Privilege," see 11 Ga. St. B. J. 16 (2005).

31-7-131. Definitions.

As used in this article, the term:

1. "Peer review" means the procedure by which professional health care providers evaluate the quality and efficiency of services ordered or performed by other professional health care providers, including practice analysis, inpatient hospital and extended care facility utilization review, medical audit, ambulatory care review, claims review, underwriting assistance, and the compliance of a hospital, nursing home, convalescent home, or other health care facility operated by a professional health care provider with the standards set by an association of health care providers and with applicable laws, rules, and regulations.
2. "Professional health care provider" means an individual who is licensed, or an organization which is approved, to practice or operate in the health care field under the laws of Georgia, including, but not limited to, the following individuals or organizations:
   1. A physician;
   2. A dentist;
   3. A podiatrist;
   4. A chiropractor;
   5. An optometrist;
   6. A psychologist;
   7. A pharmacist;
   8. A registered or practical nurse;
   9. A physical therapist;
   10. An administrator of a hospital, a nursing or convalescent home, or other health care facility;
   11. A corporation or other organization operating a hospital, a nursing or convalescent home, or other health care facility, as well as the officers, directors, or employees of such corporation or organization or the members of such corporation's or organization's governing board who are performing a peer review function;
   12. A rehabilitation supplier registered with the State Board of Workers' Compensation; and
   13. An occupational therapist.
3. "Review organization" means a nationally recognized health care accreditation body or any panel, committee, or organization:
   1. Which:
      1. Is primarily composed of professional health care providers;
      2. Is an insurer, self-insurer, health maintenance organization, preferred provider organization, provider network, or other organization engaged in managed care; or
      3. Provides professional liability insurance for health care providers; and
   2. Which engages in or utilizes peer reviews and gathers and reviews information relating to the care and treatment of patients for the purposes of:
      1. Evaluating and improving the quality and efficiency of health care rendered;
      2. Reducing morbidity or mortality;
      3. Evaluating claims against health care providers or engaging in underwriting decisions in connection with professional liability insurance coverage for health care providers;
      4. Compiling aggregate data concerning the procedures and outcomes of hospitals for the purposes of evaluating the quality and efficiency of health care services. Under no circumstances shall any such aggregate data or any other peer review information relating to an individual professional health care provider be disclosed or released to any person or entity without the express prior written consent of such health care provider, but such aggregate data or other peer review information may be released to another review organization upon the written request of such organization if such requesting review organization has specific reason to believe that immediate access to such aggregate data or information is necessary to protect the public health, safety, and welfare. Such aggregate data and other peer review information shall be used for peer review purposes only and in no event shall such aggregate data or any other peer review information be sold or otherwise similarly distributed, but a review organization shall be authorized to utilize the services of and pay a fee to another person or entity to compile or analyze such aggregate data;
      5. Evaluating the quality and efficiency of health care services rendered by a professional health care provider in connection with such provider's participation as or request to participate as a provider in or for an insurer, self-insurer, health maintenance organization, preferred provider organization, provider network, or other organization engaged in managed care; or
      6. Performing any of the functions or activities described in Code Section 31-7-15.

         (Ga. L. 1975, p. 739, § 1; Code 1933, § 84-7602, enacted by Ga. L. 1980, p. 1282, § 1; Ga. L. 1984, p. 699, § 1; Ga. L. 1985, p. 149, § 31; Ga. L. 1987, p. 656, § 1; Ga. L. 1988, p. 13, § 31; Ga. L. 1991, p. 1016, § 1; Ga. L. 1995, p. 612, § 3; Ga. L. 2001, p. 192, § 2; Ga. L. 2012, p. 337, § 3/SB 361.)

Code Commission notes. - Pursuant to Code Section 28-9-5, in 1995, "; and" was substituted for ", and" at the end of division (3)(A)(iii).

31-7-132. Immunity from liability for peer review activities; immunity from liability of persons providing information.

1. No professional health care provider nor any individual who serves as a member or employee of a professional health care provider or review organization nor any individual who furnishes counsel or services to a professional health care provider or review organization shall be held, by reason of the performance of peer review activities, to have violated any criminal law or to be civilly liable under any law unless he was motivated by malice toward any person affected by such activity.
2. No person, whether as a witness or otherwise, who provides information regarding peer review to a professional health care provider or review organization shall be held, by reason of having provided such information, to have violated any criminal law or to be civilly liable under any law unless such information is false and the person providing it knew that such information was false.

   (Ga. L. 1975, p. 739, §§ 2, 3; Code 1933, § 84-7603, enacted by Ga. L. 1980, p. 1282, § 1; Ga. L. 1987, p. 1494, § 2; Ga. L. 1995, p. 612, § 3.)

Cross references. - Immunity of medical review committee members from civil liability, § 31-7-140 et seq.

Nonliability of licensed dentist serving on peer review board for damages for any action taken by such board, § 43-11-16 .

Receipt of evidence before Georgia Composite Medical Board regarding licensee's or applicant's fitness to practice medicine, § 43-34-8 .

31-7-133. Confidentiality of review organization's records.

1. Except in proceedings alleging violation of this article, the proceedings and records of a review organization shall be held in confidence and shall not be subject to discovery or introduction into evidence in any civil action; and no person who was in attendance at a meeting of such organization shall be permitted or required to testify in any such civil action as to any evidence or other matters produced or presented during the proceedings or activities of such organization or as to any findings, recommendations, evaluations, opinions, or other actions of such organization or any members thereof. The confidentiality provisions of this article shall also apply to any proceedings, records, actions, activities, evidence, findings, recommendations, evaluations, opinions, data, or other information shared between review organizations which are performing a peer review function or disclosed to a governmental agency as required by law. However, information, documents, or records otherwise available from original sources are not to be construed as immune from discovery or use in any such civil action merely because they were presented during proceedings of such organization, nor should any person who testifies before such organization or who is a member of such organization be prevented from testifying as to matters within such person's knowledge; but such witness cannot be asked about such witness's testimony before such organization or about opinions formed by such witness as a result of the organization hearings. Notwithstanding the foregoing, the Department of Community Health may inspect and copy peer review materials maintained by certain providers when it is determined by the department to be necessary in the performance of the department's licensure and certification responsibilities under Code Section 31-7-15; provided, however, such inspection and copying shall not waive or abrogate the confidentiality of such peer review materials as set forth in this Code section and in Code Section 31-7-15.
2. This Code section shall not apply to prevent:
   1. The disclosure under Article 4 of Chapter 18 of Title 50 of those documents in the department's custody which are records, reports, or recommendations of a nationally recognized health care accreditation body and which are provided by an institution to the department for licensure purposes under subsection (b) of Code Section 31-7-3;
   2. The use of peer review documents in any proceeding involving the permitting or licensing of an institution pursuant to this chapter to the extent necessary to challenge the effectiveness of the institution's peer review system; provided, however, such use shall not waive or abrogate the confidentiality of such documents as set forth in this Code section and in Code Section 31-7-15; or
   3. A health care provider from obtaining the specific reasons and the records and proceedings related to such provider's exclusion or termination as a participating provider in a health maintenance organization, provider network, or other organization which engages in managed care if such provider has brought a civil action against such health maintenance organization, provider network, or other organization for wrongful exclusion or termination.

      (Ga. L. 1975, p. 739, § 4; Code 1933, § 84-7604, enacted by Ga. L. 1980, p. 1282, § 1; Ga. L. 1984, p. 699, § 2; Ga. L. 1985, p. 149, § 31; Ga. L. 1991, p. 1016, § 2; Ga. L. 1995, p. 612, § 3; Ga. L. 2001, p. 192, § 3; Ga. L. 2009, p. 453, § 1-4/HB 228; Ga. L. 2012, p. 337, § 4/SB 361.)

Cross references. - Privileges generally, § 24-5-501 et seq.

Privilege of state officers and employees to refuse to disclose identity of persons furnishing information pursuant to medical or public health investigation by Department of Human Resources (now the Department of Community Health for these purposes), § 50-18-72 .

Law reviews. - For note on the 2001 amendment to this Code section, see 18 Ga. St. U. L. Rev. 249 (2001).