This regulation establishes the Georgia Department of Behavioral Health and Developmental Disabilities' (DBHDD) enforcement and sanctions framework for all facilities it licenses under Title 37 (mental health) and Title 26 (drug abuse) of Georgia law. Facility operators must maintain current licenses, pay required fees, comply with corrective action plans, and post required notices during suspension or revocation actions. The Department may impose sanctions including public reprimands, fines up to $2,000 per day per violation, license suspension or revocation, and emergency orders (relocation, monitor placement, admission prohibitions) when imminent danger exists. Specifically named facility types subject to extraordinary sanctions include adult residential mental health programs (ARMH), drug abuse treatment and education programs (DATEP), narcotic treatment programs (NTP), and community living arrangements (CLA).
View official sourceSubject 82-14-1 LICENSURE ENFORCEMENT AND SANCTIONS
Rule 82-14-1-.01 Legal Authority
These rules are adopted and published pursuant to the
Official Code of Georgia Annotated (O.C.G.A.) §§
26-5-6
,
26-5-43
,
37-13-2
, and
37-3-205
.
Rule 82-14-1-.02 Title and Purpose
These rules shall be known as the Rules and Regulations for
Licensure Enforcement and Sanctions. The purposes of these rules are to provide
for general licensing and enforcement actions requirements by the Department
with respect to violations of licensing requirements by certain applicants or
licensees operating facilities subject to regulation by the Department as set
forth under Article 7 of Chapter 3 of Title 37; Chapter 13 of Title 37; and
Chapter 5 of Title 26 of the Official Code of Georgia Annotated to provide for
licensing, payment of licensing activities fees, surveys, investigations and
examinations of such facilities; compliance with corrective action plans; and
to provide that certain facilities give notice of violations giving rise to the
receipt of notice of the imposition of any sanction under federal or state laws
or regulations.
Rule 82-14-1-.03 Definitions
(1)
"Administrative action" means the
initiation of a contested case as defined in the Georgia Administrative
Procedures Act (APA), O.C.G.A. §
50-13-2(2)
.
(2)
"Alter ego" means a person who acts
pursuant to the control or influence of another while purporting to act
independently.
(3)
"Corrective
Action Plan" or "CAP" means a plan developed by the facility in response to a
violation identified on a written report of survey or investigation that
contains the steps or actions that have been taken, or are planned, to address
or correct the violation and the anticipated date of the correction.
(4)
"Commissioner" means the Commissioner of
the Department of Behavioral Health and Developmental Disabilities.
(5)
"Department" means the Department of
Behavioral Health and Developmental Disabilities, its agents and
employees.
(6)
"Document" means any
book, record, paper, or other information related to initial and continued
licensing.
(7)
"Facility" means any
agency, institution, entity or person subject to regulation by the Department
under Article 7 of Chapter 3 of Title 37; Chapter 13 of Title 37; or Chapter 5
of Title 26 of the Official Code of Georgia Annotated.
(8)
"Fee" means a payment made to the
Department for administrative services associated with licensing.
(9)
"Final Adverse Finding" means the finding
or findings set forth in or upheld by a report of the Department, order or
decision of the Commissioner, agreement between a facility and the Department,
or formal order, as of the date of:
(a)
the
issuance of a ruling by the Superior Court or Commissioner on any appeal from a
decision of a state administrative law judge, a hearing officer, or a hearing
examiner pursuant to a contested case involving the imposition of a
sanction;
(b)
the finalization by
operation of law of a decision of a state administrative law judge, a hearing
officer, or a hearing examiner when no appeal of the ruling is made;
(c)
the disposition of a contested case by
settlement between the parties; or
(d)
the expiration of the time allotted for a
facility to contest a sanction imposed by the Department, if the facility does
not properly contest the sanction within that time period.
(10)
"Fine" means a monetary sanction imposed
by the Department for violating a rule.
(11)
"Formal Order" means any ruling
following an administrative or judicial hearing or an emergency directive
issued by the Commissioner as authorized by law related to the initial or
continued licensing of a facility which requires the facility to take or
refrain from taking specified action. Formal orders include but are not limited
necessarily to final administrative hearing decisions and settlement agreements
between the Department and facilities. Additionally, formal orders, as defined
herein, may include any orders issued by the Commissioner as authorized by law,
such as but not limited to O.C.G.A. §
37-2-73
or as authorized by
similar statues enacted after the effective date of these rules.
(12)
"Imminent and substantial danger" means
an immediate threat of serious adverse outcome to a person served in a licensed
facility.
(13)
"Investigation"
means any examination, conducted in response to an allegation or allegations of
noncompliance, by the Department or its representative of a facility, including
but not necessarily limited to the premises, and staff, persons in care, and
documents pertinent to initial and continued licensing so that the Department
may determine whether a facility has violated any licensing
requirement.
(14)
"License" means
the official authorization granted by the Department pursuant to any of the
provisions of law cited in Rule 82-14-1-.01 ("Legal Authority") to operate a
facility physically located in Georgia. The term "license" includes any permit,
registration, commission, or similar designation reflecting such
authorization.
(15)
"Licensee"
means any person holding a license.
(16)
"Licensing requirements" means any
provisions of law, rule, regulation, or formal order of the Department which
apply to facilities with respect to initial or continued authority to
operate.
(17)
"Management or
Control", for the purpose of imposing the sanction pursuant to Rule
82-14-1-.06(1)(c) ("Sanctions Against Licensees") or 82-14-1-.06(2)(b)
("Sanctions Against Applicants"), means the exercise of or authority to
exercise direction, administration, or oversight over a facility's operations
by certain persons, including but not limited to owners, directors, or
administrators.
(18)
"Person" means
any individual, agent, representative, governing authority, firm, organization,
partnership, agency, association, corporation, facility, or other
entity.
(19)
"Survey" means any
monitoring visit or other inquiry by the Department of Behavioral Health and
Developmental Disabilities, or its representatives, of a facility, including
but not necessarily limited to the premises, staff, persons in care, and
documents pertinent to initial and continued licensing so that the Department
may determine whether a facility is operating in compliance with licensing
requirements or has violated any licensing requirements. Surveys may be
announced or unannounced at the discretion of the Department.
Rule 82-14-1-.04 General Licensing Requirements and Fee Schedules
(1)
No facility shall offer or provide
services which are required to be licensed under rules enforced by the
Department without a current license issued by the Department.
(2)
No license shall be issued by the
Department unless the facility is substantially in compliance with applicable
rules set forth in these rules and specific rules applicable to the particular
facility type, and all licensure activity fees due the Department have been
paid.
(3)
Fees will be assessed to
facilities and applicants for licensure for the following licensure activities:
processing applications for a new license or a change in ownership, initial
license fees, annual licensure activity fees to maintain current license,
follow-up visits to periodic surveys, training materials, returned check and
mail processing charges and civil monetary penalties.
(4)
Application for License. An application
for a license to provide regulated services shall be submitted on forms made
available by the Department in a format acceptable to the Department. No
application shall be acted upon by the Department until the application is
determined complete by the Department with all required attachments and
applicable fees submitted.
(5)
Where the Department denies an initial license for non-payment of fees or any
other reason, such action may be taken by the Department prior to an
administrative hearing on the denial being held. The applicant whose license
has been denied may obtain an administrative hearing, subsequent to the
decision to deny the license, as authorized under Georgia law.
(6)
Ongoing Licensure Activity Fees. All
licenses issued by the Department require payment of ongoing licensure activity
fees as calculated by the Department each state fiscal year, including the
state fiscal year that these rules take effect. For annual licenses, such
licensure activity fees will be due on the anniversary date of the issuance of
the previous year's license. For continuing licenses, such ongoing licensing
activity fees will be due October 31st of each state fiscal year. The annual
fees shall include the base licensure activity fee and any additional fees
incurred during the previous year. Such fees are due and payable to the
Department within thirty (30) days of receipt of the licensure activity fee
invoice. Fees will be calculated by the Department in a manner so as to help
defray the direct and indirect costs incurred by the Department in providing
such licensure activities for all facilities, but in no event shall exceed such
costs.
(7)
Effective January 1,
2026, the Department may revoke any license if the facility has failed to pay
the annually recurring licensure activity fees within sixty (60) days of
receipt of a written invoice from the Department. The revocation action is
subject to written notice of the proposed revocation and a right to receive an
administrative hearing on the amount past due and owing prior to the revocation
action becoming final.
(8)
Schedule
of Fees. Fees collected by the Department are not refundable, except in
extraordinary circumstances as determined by the Department in its sole
discretion. The decision of the Department as to whether to refund a payment is
final and may not be appealed. Payment of fees must be in a form of payment
accepted by the Department. Some forms of electronic payment may result in an
additional convenience charge being added to the licensing fee that is due. Any
convenience charge for which the user is responsible must be disclosed to the
potential user before completion of the transaction. No cash payments are
accepted by the Department. The following schedule of fees applies for the
listed licensure activities:
Licensure Activity
Fee
Fee Frequency
Application Processing Fee, Change in Ownership,
Change in Service Level (requiring on site visit), Name Change - Any
Facility
$300
Upon submission
Initial Provisional or Regular License (Same as
annual licensure activity fee for each facility type)
Varies by facility
Submitted with application processing fee
Involuntary Application Processing Fee subsequent to
unlicensed complaint investigation
$550
Follow-up Visit to Periodic Survey - Any
Facility
$250
License renewal date
Licenses and Certificates
Adult Residential Mental Health Programs**
$800
Annually
Community Living Arrangements **
$350
Annually
Drug Abuse Treatment Education Programs **
$500
Annually
Narcotic Treatment Programs **
$1,500
Annually
Miscellaneous Fees
Civil monetary penalties as finally
determined
Case-by-case basis
Late Fee: Sixty (60) days past due
$150
Per instance
Lists of Facilities by license type (electronic
only)
$25
Per request
Replacement of Lost Permit
$50
Per request
Returned check charge - as assessed by bank
<$50
Per instance
Special handling charges when required (special
courier/mailing costs)
Actual cost
Per instance
Training materials - cost to reproduce for
participant
$.25 per page, $5 per disc
Per participant
** Eligible for a 25% discount if currently
accredited by a nationally recognized accreditation organization approved by
the Department as having standards comparable to specific state licensure
requirements, and complete copy of current decision is submitted to the
Department at the time of renewal or is already on file with the
Department.
Rule 82-14-1-.05 Enforcement
(1)
The Department shall have the authority
to impose any one or more of the sanctions enumerated in paragraphs (1), (2)
and (3) of Rule 82-14-1-.06 ("Sanctions") upon a finding that an applicant or
licensee has:
(a)
Knowingly made any verbal or
written false statement of material fact either in connection with the
application for a license; or on documents submitted to the Department as part
of any survey or investigation; or in the falsification or alteration of
facility records made or maintained by the facility;
(b)
Failed or refused, without legal cause,
to provide the Department with access to the premises subject to regulation or
information pertinent to the initial and continued licensing of the
facility.
(c)
Failed to comply with
the licensing requirements of this state; or
(d)
Failed to comply with the provisions of
O.C.G.A. §
37-2-72
or with the provisions of
these rules.
(2)
The
Department's notice of intent to impose an enforcement sanction shall be made
within ninety (90) days after an application is submitted or within 90 days of
when the grounds for the action are discovered.
Rule 82-14-1-.06 Sanctions
(1)
Sanctions against Licensees.
When the Department finds that any licensee has violated any provision of Rule
82-14-1-.05 ("Enforcement"), the Department, subject to notice and opportunity
for a hearing, may impose any one or more of the sanctions in subparagraphs (a)
through (f) below.
(a)
Administer a
Public Reprimand.
If the sanction of public reprimand is finally
imposed, as defined by a final adverse finding, the public reprimand shall
consist of a notice prepared by the Department that the facility has been
reprimanded; such notice shall include a written report of the Department's
findings along with the facility's response and corrective action plan.
1.
Location of Notice.
The
facility shall post the public reprimand in places readily accessible and
continuously visible to persons in care and their representatives.
Additionally, if the facility maintains a website, it shall post a web link in
a prominent location on the main page of the website that provides access to a
copy of the public reprimand.
2.
Timing of Notice.
The facility shall post the public reprimand on
the day the public reprimand is received by the facility and such reprimand
shall remain posted for a period of ninety (90) days.
3.
Notice for Service Inquiries.
During any period that the reprimand is required to be posted, the facility
shall advise persons seeking services and representatives of persons seeking
services of the reprimand. In response to a notice by the Department of the
imposition of a public reprimand, a facility may request that the Department
not require the facility to advise persons seeking services and representatives
of persons seeking services of the reprimand if such requirement would
compromise its ability to provide services and is not feasible given the
facility's range of services and the ways its services are provided. Such
request must be made within ten (10) calendar days from receipt of the notice
from the Department. The Department upon such a convincing showing, as well as
a showing that the correction of the violation has been achieved and will be
sustained by the facility, may elect not to enforce this requirement. If the
Department elects to enforce the requirement and the facility appeals the
imposition of the sanction, the issue of this requirement may become an issue
for consideration by the hearing examiner at any hearing held on the sanction,
unless waived by the facility.
(b)
Suspend any License.
The
Department may suspend for a definite period or for an indefinite period in
connection with any condition which may be attached to the restoration of said
license.
1.
The Department may impose the
sanction of suspension for a definite period calculated by it as the period
necessary for the facility to implement long-term corrective measures and for
the facility to be deterred from lapsing into noncompliance in the future. As
an alternative to suspending a license for a definite period, the Department
may suspend the license for an indefinite period in connection with the
imposition of any condition or conditions reasonably calculated to elicit
long-term compliance with licensing requirements which the facility must meet
and demonstrate before it may regain its license.
2.
If the sanction of license suspension is
finally imposed, as defined by a final adverse finding, the Department shall
effectuate it by requiring the facility to return its license to the
Department. Upon the expiration of any period of suspension, and upon a showing
by the facility that it has achieved compliance with licensing requirements,
the Department shall reissue the facility a license. Where the license was
suspended for an indefinite period in connection with conditions for the
re-issuance of a license, once the facility can show that any and all
conditions imposed by the Department have been met, the Department shall
reissue the facility a license.
3.
The official notice of the suspension action and any final resolution, together
with the Department's complaint intake phone number and website address, shall
be provided to current and prospective clients and to their representatives and
family units, as applicable.
(i)
The facility
shall post the official notice at the facility location in an area that is
visible to the clients and to the clients' representatives and family
units.
(ii)
The facility shall
ensure that the notice continues to the visible to the clients and to their
representatives and family units throughout the suspension action, including
during any appeals.
(iii)
The
facility shall have readily visible to the clients and to their representatives
and family units any survey reports that are prepared by the Department during
the pendency of a suspension action.
(iv)
It shall be a violation of these rules
for the facility to permit the removal or obliteration of any notices required
by this rule during the pendency of any suspension.
(v)
The Department may share any notice of
the suspension and any information pertaining thereto with any other agencies
that may have an interest in the welfare of the clients in care at the
facility.
(c)
Prohibit Persons in Management or Control.
The Department may
prohibit a licensee from allowing a person who previously was involved in the
management or control of any facility which has had its license revoked or
application denied within the past twelve (12) months to be involved in the
management or control of such facility. Any such person found by the Department
to have acted diligently and in good faith to ensure correction of violations
in a facility which has had its license revoked or denied, however, shall not
be subject to this prohibition if that person became involved in the management
or control of the facility after the facility was notified by the Department of
violations of licensing requirements giving rise to a revocation or denial
action. This subparagraph shall not be construed to require the Department to
obtain any information that is not readily available to it regarding any
person's involvement with a facility. For the purpose of this Rule, the twelve
(12) month period will begin to run from the date of any final adverse finding
or the date that any stay of enforcement ceased, whichever first
occurs.
(d)
Revoke any
License.
The Department may revoke any license. If the sanction of
license revocation is finally imposed, as defined by a final adverse finding,
the Department shall effectuate it by requiring the facility to return its
license to the Department.
1.
The official
notice of the revocation action and any final resolution, together with the
Department's complaint intake phone number and website address, shall be
provided to current and prospective clients and to their representatives and
family units, as applicable.
2.
The
facility shall post the official notice at the facility location in an area
that is visible to the clients and to the clients' representatives and family
units.
3.
The facility shall ensure
that the notice continues to the visible to the clients and to their
representatives and family units throughout the revocation action, including
during any appeals.
4.
The facility
shall have readily visible to the clients and to their representatives and
family units any survey reports that are prepared by the Department during the
pendency of a revocation action.
5.
It shall be a violation of these rules for the facility to permit the removal
or obliteration of any notices required by this rule during the pendency of any
revocation.
6.
The Department may
share any notice of the revocation action and any information pertaining
thereto with any other agencies that may have an interest in the welfare of the
clients in care at the facility.
(e)
Impose a Civil Penalty Fine.
The Department may impose a civil penalty fine of up to $2,000 per day for each
violation of a law, rule, regulation, or formal order related to the initial or
continued licensing of a facility; provided, however, that no such fines shall
exceed $40,000 for violations found during the same survey. If a violation is
found on two (2) consecutive surveys, there shall exist a rebuttable
presumption that the violation continued throughout the period of time between
each survey.
1.
Categories of
Violations.
Violations shall be assigned a severity category based upon
the following criteria:
(i)
Critical
Risk
($1,201-$2,000 fine per violation per day): A violation or
combination of violations of licensing requirements which has caused death or
serious physical or emotional harm to a person or persons in care or poses an
imminent and serious threat or hazard to the physical or emotional health and
safety of one or more persons in care;
(ii)
High Risk
($601-$1,200 fine
per violation per day): A violation or combination of violations of licensing
requirements which has direct adverse effect on the physical or emotional
health and safety of a person or persons in care; and
(iii)
Moderate Risk
($300-$600
fine per violation per day): A violation or combination of violations of
licensing requirements which indirectly or over a period of time has or has the
potential to result in an adverse effect on the physical or emotional health
and safety of a person or persons in care, or a violation or violations of
administrative, reporting, or notice requirements.
(iv)
Low Risk
(no fine): A
violation that has little to no impact to individuals served.
2.
Fine Amounts.
The
specific amount of the fine for each violation in each category shall be
determined based upon whether and when the particular or similar rule, law, or
order, or the act, omission, incident, circumstance, or conduct giving rise to
the violation of the same regulatory requirement, or one substantially similar
thereto, has been cited by the Department previously, and the scope of the
violation.
(i)
Initial Violation.
If the same or a substantially similar violation has not been cited previously
by the Department within the past twenty-four (24) months against the facility,
it shall be considered to be an initial violation. The fine amount for initial
violations shall be the bottom figure in the appropriate category.
(ii)
Second Violation.
If the
present violation or a substantially similar violation had been found and cited
by the Department as the result of the last survey of the facility, or as the
result of any one other survey during the previous twenty-four (24) months, the
violations shall be considered to be a second violation. The fine amount for
second violations shall be in the range between the top and bottom figures of
the appropriate category and other factors, such as the existence of mitigating
or aggravating circumstances, shall be considered in determining the fine
amount within the range.
(iii)
Repeated Violation.
If the present violation or a substantially
similar violation also had been found and cited any two (2) other times during
the past twenty-four (24) months, it shall be considered to be a repeated
violation. The fine amount for repeated violations shall be the top figure in
the category.
3.
Limitation of Fines.
(i)
A single
act, omission, incident, circumstance, or conduct shall not give rise to the
imposition of more than one fine even though such act, omission, incident,
circumstance, or conduct may have violated more than one licensing requirement.
In such a case, the fine shall be based upon the highest category in which any
one violation resulting from the same act, omission, incident, circumstance, or
conduct falls.
(ii)
Correction by
the facility of cited violations tolls the continuation of the assessment of
the daily fine, provided, however, that the Department shall confirm that such
cited violations were corrected.
(iii)
In no case shall a facility be
sanctioned for a violation characterized as a subsequent or repeat violation
unless the time frame identified in the acceptable corrective action plan has
passed and the facility nonetheless has failed to attain or maintain
correction.
4.
Financial Hardships.
In response to a notice by the Department of
the imposition a fine, a facility may request that the Department reduce the
fine amount if the fine would cause significant financial hardship that would
compromise its ability to provide care or services in compliance with licensing
requirements. The Department, in its discretion, upon such a convincing showing
as well as a showing that correction of the violation has been achieved and
will be sustained by the facility, may reduce the amount of the fine. If the
Department proceeds with the imposition of the fine as proposed, the issue of
significant financial hardship may become an issue for consideration by the
hearing examiner at any hearing held on the sanction, unless waived by the
facility.
(f)
Limit
or Restrict any License.
The Department may limit or restrict any
license as the Department deems necessary for the protection of the public (a
provisional or temporary time-limited license granted by the Department shall
not be considered to be a limited or restricted license).
1.
Limitation or restriction of a license may
occur to:
(i)
prohibit the provision of a
particular service or services when a facility is unable or unwilling to render
or perform the service or services in compliance with licensing
requirements;
(ii)
restrict the
authorized number of persons cared for by a facility when the facility is
unable or unwilling to render care in compliance with licensing requirements;
and/or
(iii)
prohibit a facility
from caring for persons with specific types or degrees of needs that the
facility is not capable of meeting in compliance with licensing
requirements.
2.
If the
sanction of license limitation or restriction is finally imposed, as defined by
a final adverse finding, the Department shall effectuate it by sending the
facility a restricted or limited license. Upon receipt of the restricted or
limited license, the facility shall return to the Department its original
license. Upon expiration of the restriction or limitation period, and upon
proof by the facility that it has taken effective corrective action and has
sustained that action during the period of the sanction, the Department shall
fully restore the facility's license. The Department shall take any steps it
deems necessary to verify compliance prior to the expiration of the sanction
period so that a compliant facility is restored its license without
delay.
(2)
Sanctions against Applicants.
When the Department finds that any
applicant for a license has violated any provision of Rule 82-14-1-.05
("Enforcement"), the Department, subject to notice and opportunity for a
hearing, may impose any one or more of the following sanctions in subparagraphs
(a) through (c) below.
(a)
Refuse to
Grant License.
The Department may refuse to grant (deny) a license;
provided, however, that the Department may refuse to grant an initial license
without holding a hearing prior to taking such action.
1.
The Department may deny an application for
a license where the facility has failed to demonstrate compliance with
licensing requirements. Additionally, the Department may deny an application
for a license where the applicant or alter ego of the applicant has had a
license denied, revoked, or suspended within one year of the date of an
application, or where the applicant has surrendered the license or transferred
ownership or governing authority of a facility within one year of the date of a
new application when such surrender or transfer was made in order to avert
denial, revocation, or suspension of a license or payment of fines.
2.
For the purpose of determining the
one-year denial period, the period shall begin to run from the date of the
final adverse finding, or the date any stay of enforcement ceased, whichever
first occurs.
3.
In further
determining whether to grant or deny a license, the Department may consider the
applicant's overall record of compliance with licensing requirements.
(b)
Prohibit Persons in
Management or Control.
The Department may prohibit an applicant from
allowing a person who previously was involved in the management or control of
any facility which has had its license revoked or application denied within the
past twelve (12) months to be involved in the management or control of such
facility. Any such person found by the Department to have acted diligently and
in good faith to ensure correction of violations in a facility which has had
its license revoked or denied, however, shall not be subject to this
prohibition if that person became involved in the management or control of the
facility after the facility was notified by the Department of violations of
licensing requirements giving rise to denial action. This subparagraph shall
not be construed to require the Department to obtain any information that is
not readily available to it regarding any person's involvement with a facility.
For the purpose of this rule, the twelve (12) month period will begin to run
from the date of any final adverse finding or the date that any stay of
enforcement ceased, whichever first occurs.
(c)
Limit or Restrict any
License.
The Department may limit or restrict any license as it deems
necessary for the protection of the public (a provisional or temporary
time-limited license granted by the Department shall not be considered to be a
limited or restricted license).
1.
Limitations
or restrictions of a license may include any or all of the following as
determined necessary by the Department:
(i)
prohibiting the provision of a particular service or services when a facility
is unable or unwilling to render or perform the service or services in
compliance with licensing requirements;
(ii)
restricting the authorized number of
persons cared for by a facility when the facility is unable or unwilling to
render care in compliance with licensing requirements; and
(iii)
prohibiting a facility from caring for
persons with specific types or degrees of needs that the facility is not
capable of meeting in compliance with licensing requirements.
2.
The Department may restrict a
license where any applicant or alter ego of the applicant has had a license
denied, revoked, or suspended within one (1) year of the date of an
application, or where the applicant has surrendered the license or transferred
ownership of governing authority of a facility within one (1) year of the date
of a new application when such surrender or transfer was made in order to avert
denial, revocation, suspension of a license, or payment of fines. For the
purpose of determining the one (1) year denial period, the period shall begin
to run from the date of the final adverse finding or the date any stay of
enforcement ceased, whichever occurs first.
3.
If the sanction of license limitation or
restriction is finally imposed, as defined by a final adverse finding, the
Department shall effectuate it by sending the facility a restricted or limited
license. Upon receipt of the restricted or limited license, the facility shall
return to the Department its original license if one was granted. Upon
expiration of the restriction or limitation period, and upon proof by the
facility that it has taken effective corrective action and has sustained that
action during the period of the sanction, the Department may issue the facility
a license. The Department shall take any steps it deems necessary to verify
compliance prior to the expiration of the sanction period so that a compliant
facility may be issued a license without delay.
(3)
Extraordinary Sanctions Where
Imminent and Substantial Danger.
Where the Commissioner of the
Department determines that the patients or residents in the care of an adult
residential mental health program (ARMH), drug abuse treatment and education
program (DATEP), narcotic treatment program (NTP), or community living
arrangement (CLA) subject to licensure by the Department are subject to an
imminent and substantial danger, the Commissioner may order any of the
extraordinary sanctions listed in subsections (b), (c), (d) and (e), of this
rule, 82-14-1-.06(3) ("Extraordinary Sanctions Where Imminent and Substantial
Danger"), to take effect immediately unless otherwise specified in the order,
without notice and opportunity for hearing prior to the order taking effect.
(a)
Content of the Order.
The
order shall contain the following:
1.
the
scope of the order;
2.
reasons for
the issuance of the order;
3.
effective date of the order if other than the date the order is
issued;
4.
person to whom questions
concerning the order are to be addressed; and
5.
notice of the right to obtain after the
issuance of the order, a preliminary hearing and an administrative hearing
regarding the emergency order as a contested case.
(b)
Emergency Relocation.
The
Commissioner may order emergency relocation of the patients or residents of any
facility to the nearest appropriate facility of the same type. Prior to issuing
an emergency order, the Commissioner or his/her designee may consult with
persons knowledgeable in the field of medical care and a representative of the
facility to determine if there is a potential for greater adverse effects on
patient or resident care as a result of the proposed issuance of an emergency
order. The Commissioner shall provide for 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 therefore; relocation to the nearest appropriate
facility of the same type and other protection designed to ensure the welfare
and, when possible, the desires of the patient or resident.
1.
When provided with the notice of the
execution of the emergency relocation order, the facility shall make
patient/resident information available to the Department in usable
formats.
2.
The facility that is
the subject of the emergency relocation order shall not impede in any way the
Department's communications with the patients/residents, next of kin or
guardians of the patients/residents and attending physicians.
3.
The facility shall continue to provide
care and services to the patients/residents and shall prepare records required
by the receiving facility which are necessary to facilitate continuity of
patient/resident care for the patients/residents to be relocated.
4.
The facility shall make any personal
property, such as but not limited to patient/resident funds, available to the
receiving facility at the time of transfer.
(c)
Emergency Placement of
Monitor.
The Commissioner may order the emergency placement of a monitor
in a facility subject to licensure when conditions at the facility require
immediate oversight for the safety of the patients or residents.
1.
Conditions.
The placement of
a monitor may be required when one or more of the following circumstances are
present:
(i)
the facility is operating without
a permit or license;
(ii)
the
Department has denied the application for a permit or a license or has
initiated an action to revoke the existing permit or license of the
facility;
(iii)
the facility is
closing or plans to close and adequate arrangement for the relocation of the
patients or residents have not been made at thirty (30) days before the date of
closure; or
(iv)
the health,
safety, security, rights or welfare of the patients or residents cannot be
adequately assured by the facility. For example, the Department is informed
that essential service vendors (electricity, gas, water, food or pharmacy) have
not been paid and anticipate discontinuing service and the facility does not
have a signed contract with another vendor establishing that there will be no
disruption in service.
2.
Role of Monitor.
The monitor may be placed in the facility for no
more than ten (10) days, during which time the monitor shall observe conditions
and compliance with remedial action recommended by the Department. The monitor
shall not assume any administrative responsibility for the facility, nor shall
the monitor be liable for any of the actions of the facility.
3.
Cost of Monitor.
The facility
shall pay the costs associated with the placement of the monitor unless the
Commissioner's order placing the monitor is determined to be invalid in a
contested case proceeding under the Georgia Administrative Procedure Act,
Chapter 13 of Title 50.
(d)
Emergency Prohibition of
Admissions.
The Commissioner may order the emergency prohibition of
admissions to a facility when such facility has failed to correct a violation
of Departmental permit rules within a reasonable period of time, as specified
in the Department's corrective order, and the violation could either jeopardize
the health and safety of the residents/patients if allowed to remain
uncorrected or is a repeat violation over a twelve (12) month period, which is
intentional or due to gross negligence.
(e)
Emergency Suspension of
Admissions.
The Commissioner may order that admissions to a facility be
suspended until the Department has determined that the violation has been
corrected or until the Department has determined that the facility has
undertaken the action necessary to effect correction of the
violation.
(f)
Preliminary
Hearing.
The facility affected by the Commissioner's emergency order may
request that the Department hold a preliminary hearing within the Department on
the validity of the order and the need for its continuation. Such hearing shall
occur within ten (10) days following the request.
1.
A request for a preliminary hearing shall
be made in writing to the representative of the Department designated in the
emergency order. Unless a request is made to appear in person, the preliminary
hearing shall consist of an administrative review of the record, written
evidence submitted by the institution affected, and a preliminary written
argument in support of its contentions.
2.
If a request is made to appear in person
at the preliminary hearing, the following information shall be included in the
request, or provided prior to the hearing:
(i)
the name and address of person or persons, if any, who will be representing the
facility in the preliminary hearing;
(ii)
the names and titles of all other
persons who will attend the preliminary hearing; and
(iii)
any additional evidence the facility
wishes to submit for consideration at the hearing.
3.
Upon receipt of a request for a
preliminary hearing, the Department shall set and give notice of the date,
time, and location of the preliminary hearing. The preliminary hearing shall be
held within ten (10) calendar days of receipt of the request.
4.
If a personal appearance is requested, the
preliminary hearing shall consist of a review of the evidence in the record;
any additional evidence introduced at the hearing; and any arguments made. A
sound recording shall be made of the hearing.
5.
Within seven (7) calendar days of the
close of the preliminary hearing, the Department shall render a written
decision. The decision shall be divided as follows:
(i)
description of additional evidence
submitted by the affected facility;
(ii)
summary of the arguments and/or brief
submitted by the facility in support of its contention that the emergency order
is invalid;
(iii)
a statement as to
whether the emergency order issued by the Department is found valid and the
reasons therefore; and
(iv)
notice
of the affected facility's right to obtain an administrative hearing regarding
the Commissioner's emergency order pursuant to O.C.G.A. §
50-13-13
, if the emergency order
is found valid as a result of the Department's preliminary hearing.
6.
Pending final appeal of the
validity of any emergency order issued as provided herein through the
administrative hearing process, such emergency order shall remain in full
effect until vacated or rescinded by the Commissioner.
(g)
Cumulative Remedy.
The
Department is not limited to a single emergency action under these rules, nor
is the Department precluded from other actions permitted by other law or
regulations during the time an emergency order is in force.
(4)
Standards for Taking
Sanctions.
In taking any of the actions pursuant to subparagraphs (1),
(2) or (3) of this rule, the Department shall consider the seriousness of the
violation or violations, including the circumstances, extent, and gravity of
the prohibited act or acts or failure to act, and the hazard or potential
hazard created to the physical or emotional health and safety of the
public.
(5)
Non-Compliance
with Sanctions.
Failure on the part of any facility to abide by any
sanction, including payment of a fine, which is finally imposed against it,
shall constitute grounds for the imposition of additional sanctions, including
revocation.
(6)
Settlements.
With regard to any contested case instituted by the
Department pursuant to this Chapter or other provisions of law or regulation
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, the Department, the facility, and
those persons deemed by the Department to be successors in interest to any
settlement agreement, shall be bound by the terms specified therein. Violation
thereof by any applicant or licensee, their agents, employees, or others acting
on their behalf, shall constitute grounds for the imposition of any sanctions
enumerated in this Chapter, including revocation.
Rule 82-14-1-.07 Surveys, Investigations and Corrective Action Plans
(1)
Authority to Inspect.
The
Department is authorized to conduct an survey to determine whether a facility
is operating in compliance with licensing requirements or has violated any
licensing requirements. Such surveys 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.
(2)
Authority to Investigate.
Where the Department determines that a rule violation related to a complaint or
a reportable incident may have occurred, the Department may initiate an
investigation. 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.
(3)
Consent to Entry and Access.
An application for a license or the issuance of the same by the Department
constitutes consent by the applicant or licensee and the owner of the premises
for the Department's representatives, after displaying identification to any
facility staff, to enter the facility for the purpose of conducting an
investigation or an survey. Department representatives shall be allowed,
without delay, reasonable and meaningful access to the facility's premises, and
information pertinent to licensure including staff and persons in care. The
Department shall have the authority to require the production of any documents
related to the initial and continued licensing of any facility.
(4)
Cooperation with Survey.
Facility staff shall cooperate with any survey or investigation conducted by
the Department and shall provide, without unreasonable delay, any documents
which the Department is entitled hereunder.
(5)
Assessment of Expenses.
Pursuant to the survey, investigation, and enforcement powers given to the
Department by O.C.G.A. §
37-2-72
and other applicable laws,
and the provisions of this Chapter, the Department may assess against a
facility reasonable and necessary expenses incurred by the Department pursuant
to any administrative or legal actions required by the failure of a facility to
fully comply with licensing requirements. Such expenses may be assessed only
pursuant to the initiation of sanction actions under this Chapter and may only
be collected if such actions result in final adverse findings. A facility shall
be notified of the Department's action to assess expenses when the Department
sends a facility a notice of the sanction. If the sanction is appealed, the
assessment may become an issue for consideration by the hearing examiner at any
hearing held on the sanction.
(a)
Reasonable and Necessary Expenses.
Reasonable and necessary
expenses, as used in this subparagraph, shall include, but not necessarily be
limited to: hourly compensation of Department representatives, commuting
expenses (including mileage at the current state reimbursement rate), and
lodging and meal expenses (at the rate approved for reimbursement by the state)
associated with overnight out-of-town travel; and other similar costs.
Assessments shall not include attorney's fees and expenses of litigation, shall
not exceed actual expenses, and shall be made only if surveys, investigations,
or enforcement actions result in final adverse findings.
(b)
Payment of Assessed
Expenses.
Expenses assessed against a facility shall be paid within
thirty (30) days of receipt of a statement of expenses. In response to an
assessment, a facility may request that the Department reduce the assessment or
agree to a payment plan if full payment within thirty (30) days would cause
significant financial hardship that would compromise its ability to provide
care or services in compliance with licensing requirements. The issue of
significant financial hardship caused by the assessment may become an issue for
consideration by the hearing examiner at any hearing held on the
sanction.
(6)
Violations Report.
The outcome of the investigation/survey shall
be provided by the Department to the facility after the investigation/survey is
completed; provided however, that the names and identifying information
regarding the complainants are classified as confidential. Nothing in this rule
shall be construed to require the Department to release the name or identifying
information regarding a complainant without first obtaining proper
authorization from such complainant. Nor shall this rule be construed to
require the Department to release any other confidential or privileged
information without first obtaining proper authorization.
(7)
Corrective Action Plan
. The
facility shall develop a corrective action plan within fifteen (15) days of a
written report of violations.
(a)
If the
initial corrective action plan is unacceptable to the Department, the facility
will be provided with at least one (1) opportunity to revise the unacceptable
corrective action plan.
(b)
The
facility shall comply with the corrective action plan accepted by the
Department.
(c)
Where the
Department determines that the facility either has not filed an acceptable
corrective action plan or has not complied with the accepted corrective action
plan, the Department may initiate one or more sanctions as described in Rule
82-14-.06 ("Sanctions).
(d)
The
Department may require the provider to develop an "internal corrective action
plan" which does not need to be submitted to the Department, except at the
request of the Department. The "internal corrective action plan" must meet all
other requirements of a corrective action plan.
(8)
Violations Dispute.
The
facility may offer an explanation for or dispute the Department's findings of a
violation s of licensing rules within ten (10) days of an survey or
investigation report showing such finding(s). When the Department transmits the
survey or investigation report to the facility, the Department shall include
instructions for how such an explanation or dispute can be made, and the
facility must make such explanation or dispute as directed in those
instructions. At a minimum, the instructions must include directions on how the
facility can initiate an administrative action (as defined in Rule 82-14-1-.03,
"Definitions"); provided, however, that the Department may (but is not required
to) provide for a prior process of administrative review by the Department
before the matter is ripe for administrative action before agencies or courts
outside the Department.
Rule 82-14-1-.08 Immunity
For any action taken or any proceeding held under this
Chapter 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.
Rule 82-14-1-.09 Exemptions
In an administrative or legal proceeding under this Chapter,
a person claiming an exemption or an exception granted by law, rule,
regulation, or formal order has the burden of proving this exemption or
exception.
Rule 82-14-1-.10 Applicability of Administrative Procedures Act
This Chapter and all sanction actions resulting from its
provisions shall be administered in accordance with Chapter 13 of Title 50 of
the Official Code of Georgia Annotated, the Georgia Administrative Procedure
Act. Any request for hearing in response to any sanction action undertaken
pursuant to this Chapter shall be in writing and shall be submitted to the
Department no later than 10 calendar days from the date of receipt of any
notice of intent by the Department to impose a sanction setting forth the
proposed sanction or sanctions and the basis therefore.
Rule 82-14-1-.11 Applicability of Other Laws
The provisions of this Chapter 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 Chapter
limits such grounds or actions, those other provisions shall
apply.
Rule 82-14-1-.12 Survey Warrants
In addition to the enforcement actions authorized by this
Chapter with respect to refusal to provide the Department with access to a
facility, the Department may make application to a court of competent
jurisdiction for an survey warrant if its representatives are denied meaningful
access to the premises, staff, persons in care, and documents or other
information of a licensed facility or of a facility which the Department
believes is required to have a license but which does not have one. Upon the
grant of such a warrant, the Department may gain entry and meaningful access to
such facility, its staff, and persons in care therein, facility documents, and
other information deemed pertinent by the Department to making a compliance
determination, unless the warrant specifically limits the entry or access
allowed to Department representatives. This rule shall not be construed to
require the Department to seek entry and be denied the same before it may apply
for a survey warrant.
Rule 82-14-1-.13 Injunctive Relief
The Department may, without regard to the availability of
other remedies, including the remedies set forth in this Chapter, seek an
injunction against the continued operation of a facility without a license. The
Department likewise may seek injunctive relief against the continued operation
of a facility in violation of licensing requirements.
Rule 82-14-1-.14 Severability
In the event that any rule, sentence, clause or phrase of any
of these rules and regulations may be construed by any court of competent
jurisdiction to be invalid, illegal, unconstitutional, or otherwise
unenforceable, such determination or adjudication shall in no manner affect the
remaining rules or portions thereof. The remaining rules or portions thereof
shall remain in full force and effect as if such rule or portions thereof so
determined, declared or adjudicated invalid or unconstitutional were not
originally part of these rules.
Rule 82-14-1-.01 Legal Authority
Rule 82-14-1-.02 Title and Purpose
Rule 82-14-1-.03 Definitions
Rule 82-14-1-.04 General Licensing Requirements and Fee Schedules
Rule 82-14-1-.05 Enforcement
Rule 82-14-1-.06 Sanctions
Rule 82-14-1-.07 Surveys, Investigations and Corrective Action Plans
Rule 82-14-1-.08 Immunity
Rule 82-14-1-.09 Exemptions
Rule 82-14-1-.10 Applicability of Administrative Procedures Act
Rule 82-14-1-.11 Applicability of Other Laws
Rule 82-14-1-.12 Survey Warrants
Rule 82-14-1-.13 Injunctive Relief
Rule 82-14-1-.14 Severability