Ga. Comp. R. & Regs. 82-8-1

82-8-1 EMERGENCY RECEIVING, EVALUATING AND TREATMENT FACILITIES

This chapter establishes the standards and designation process for Emergency Receiving, Evaluating, and Treatment Facilities in Georgia, governing both private hospitals and Crisis Stabilization Units (CSUs) approved by DBHDD under Title 37. Designated facilities must comply with hospital regulations, maintain appropriate psychiatric staffing, provide seclusion rooms meeting specified standards, and follow DBHDD Provider Manuals and discharge planning best practices. The chapter also sets out enforcement mechanisms—including suspension or removal of designation—and procedures for transfer of individuals between private and state-operated facilities.

Subject 82-8-1 EMERGENCY RECEIVING, EVALUATING AND TREATMENT FACILITIES

Rule 82-8-1-.01 Authority

The legal authority for this Chapter is Chapters 3 and 7 of
 Title 37 of the Official Code of Georgia, Annotated.

Rule 82-8-1-.02 Definitions

(1)

 Unless a different meaning is required by
 the context, the following terms as used in this Rule shall have the meaning
 hereinafter ascribed to them: 

(a)

 The term
 "private facility" means any hospital facility that is a proprietary hospital
 or a hospital operated by a nonprofit corporation or association approved for
 the purposes of Chapter 3 or Chapter 7 of Title 37 of the Official Code of
 Georgia Annotated, as provided herein, or any hospital facility operated by a
 hospital authority created pursuant to the "Hospital Authorities Law," Article
 4 of Chapter 7 of Title 31. DBHDD's approval or designation of a private
 facility for such purposes does 
not
 make the facility
 a "state owned" or "state operated" facility within the meaning of Title 37 or
 of this Chapter of regulations.

(b)

 The term "Crisis Stabilization Unit" (CSU) means a short-term residential
 program operated for the purpose of providing psychiatric stabilization and
 detoxification services that complies with applicable department standards and
 that provides brief, intensive crisis services 24 hours a day, seven days a
 week (these standards also apply to Behavioral Health Crisis Centers (BHCCs))
 which complies with applicable DBHDD Provider Manuals. CSUs are not "state
 owned" or "state operated" facilities by reason of Title 37 or of this Chapter
 of regulations.

(c)

 The term
 "department" means the Department of Behavioral Health and Developmental
 Disabilities of the State of Georgia.

(d)

 The term "emergency receiving facility"
 means a facility designated by the department to receive patients under
 emergency conditions as provided in Part 1 of Article 3 of Chapter 3, or Part 1
 of Article 3 of Chapter 7, of Title 37.

(e)

 The term "evaluating facility" means a
 facility designated by the department to receive patients for evaluation as
 provided in Part 2 of Article 3 of Chapter 3, or Part 2 of Article 3 of Chapter
 7, of Title 37.

(f)

 The term
 "treatment facility" means a facility designated by the department to receive
 patients for treatment as provided in Part 3 of Article 3 of Chapter 3, or Part
 3 of Article 3 of Chapter 7, of Title 37.

(g)

 The term "Psychiatrist" means any
 physician certified as a Diplomat in Psychiatry by the American Board of
 Psychiatry and Neurology, or who has completed three years of approved
 residency training program in psychiatry and has had two years of full-time
 practice in this specialty.

(h)

 The
 term "VA" means the United States Department of Veterans Affairs.

Rule 82-8-1-.03 Designation as Emergency Receiving, Evaluating and Treatment Facilities

The department may designate as an Emergency Receiving,
 Evaluating, and/or Treatment Facility any private facility or any such portion
 of a community mental health and substance abuse program which complies with
 the standards for a CSU within the State of Georgia at the request of or with
 the consent of the governing officers of such facility.

(1)

 A VA hospital may lawfully act as an
 emergency receiving facility, evaluating facility, or treatment facility
 pursuant to O.C.G.A. § 
37-3-102(a)

 without having been designated as such by the department.

(2)

 Any private facility or any CSU
 requesting approval and designation as an Emergency Receiving, Evaluating, or
 Treatment Facility will make application on forms approved by the
 department.

(3)

 Any Crisis
 Stabilization Unit (CSU), to be eligible for designation, shall be a part of a
 comprehensive community mental health and substance abuse program which
 comprehensive program has been certified by DBHDD, to be in compliance with
 applicable DBHDD Provider Manuals.

(4)

 Any private facility seeking designation
 by the department must attest that it is compliant with, and must maintain
 compliance with, the requirements pertaining to emergency receiving,
 evaluation, and treatment facilities set forth in State of Georgia Rules and
 Regulations for Hospitals (Georgia Comp. R. & Regs §) and Guidelines for
 the Design and Construction of Hospitals and Healthcare Facilities. The private
 facility must submit its attestation of compliance annually.

(5)

 The facility designated will provide only
 those emergency receiving, evaluation and/or treatment services for which it
 has received prior approval from DBHDD.

(6)

 If a facility already designated as an
 Emergency Receiving Facility, an Evaluating Facility, and/or a Treatment
 Facility wishes to add an additional designation, such additional designation
 requires approval from DBHDD. (For example, if a facility designated only as an
 Emergency Receiving Facility wishes also to be designated as an Evaluating
 Facility, DBHDD must approve and confer such designation.)

(7)

 If a facility moves to a different
 location, the facility must submit a new application to DBHDD, which will
 follow its procedure in designating the new facility location as an Emergency
 Receiving, Evaluating, and/or Treatment Facility. A facility's designation is
 not transferrable to another location.

(8)

 The facility must remain in compliance
 with the CMS regulations and accrediting body standards. 

(a)

 When the Center for Medicare and Medicaid
 Services (CMS) or any accrediting body makes any findings related to a
 designated facility's Emergency Receiving, Evaluation, and/or Treatment
 services, the facility must provide DBHDD with those findings within 30 days of
 the date on which the findings are communicated to the facility.

(b)

 Additionally, a copy of any corrective
 action plan (including any amended corrective action plan or in-process
 corrective action plan) developed by the facility in response to such findings
 must be forwarded to DBHDD by the facility within 30 days of the date on which
 the facility communicates the corrective action plan to CMS or the accrediting
 body.

(9)

 If a designated
 facility is notified that it will lose or has lost any license, or will incur
 or has incurred a restriction or suspension of any license, the designated
 facility must notify DBHDD within 24 hours of its receipt of such
 notice.

(10)

 If a designated
 facility wishes to remove one or more of its own designations, the facility
 shall give written notice to DBHDD at least 30 days in advance of the date on
 which it intends to cease operating under that designation.

(11)

 As the department is the best suited
 entity to determine which facility will be the nearest of its available
 facilities to which an individual needing admission may be admitted, and as
 O.C.G.A. § 
37-3-100(a)
 and
 O.C.G.A. § 
37-7-100(a)

 provide the department with discretion to designate the state-owned or
 state-operated facility to which an individual will be admitted for emergency
 receiving, evaluation, and/or treatment, the department shall establish,
 maintain, and make publicly available procedures by which a determination is
 made to which state-owned or state-operated facility an individual will be
 admitted in the event that the individual is not admitted to a private
 facility. The department shall make every effort to encourage any person or
 entity responsible for transporting or for directing transport of an individual
 to a facility under the terms of Title 37, Chapter 3 and Chapter 7, to make use
 of these procedures.

(12)

 As
 O.C.G.A. § 
37-3-100(a)
 and
 O.C.G.A. § 
37-7-100(a)

 provide that the department may designate a private facility as the facility to
 which an individual is to be admitted for emergency receiving, evaluation,
 and/or treatment if the department has obtained prior agreement of the private
 facility, a private facility may decline admission to an individual or limit
 admission to a class of individuals where such declination is otherwise lawful.
 Private facilities are reminded that they may be required to comply with the
 Emergency Medical Treatment and Labor Act (EMTALA), the Americans with
 Disabilities Act (ADA), and other applicable federal laws.

(13)

 The department possesses the discretion,
 under O.C.G.A. § 
37-3-100(d)
 and
 O.C.G.A. § 
37-7-100(d)
, to
 transfer an individual from one state-owned or state-operated facility to
 another state-owned or state-operated facility. 

(a)

 Such a transfer may be directed to
 accomplish efficient utilization of a facility as determined by the facility
 and the department.

(b)

 Individuals
 in voluntary legal status may only be transferred with their consent.

(c)

 Notice of any such transfer shall be
 provided to the individual and the individual's representatives, and the
 individual shall be informed in writing as to the reasons for the
 transfer.

(14)

 If a
 private facility or an individual requests a transfer of an individual who has
 been admitted to a private facility under Title 37, Chapter 3 or Chapter 7,
 from the private facility to a state-owned or state-operated facility, and the
 individual meets criteria for admission to the department's facility, the
 department is required to accept admission of the individual to the state-owned
 or state-operated facility that the department determines is the most
 appropriate.

(15)

 If an individual
 hospitalized in a state-owned or state-operated facility under Title 37,
 Chapter 3 or Chapter 7, requests transfer to a private facility, the department
 shall transfer the individual to the facility if (i) the individual can pay for
 the individual's treatment at the private facility and (ii) the private
 facility agrees to accept the individual.

(16)

 As set forth in O.C.G.A. § 
37-3-101
 and O.C.G.A. § 
37-7-101
, the governing body of
 the county of residence of the individual involved is required, subject to
 Court direction, to arrange for emergency transport to an emergency receiving
 facility. The governing body of the county of residence of the individual
 involved further bears responsibility for all required transportation for
 mental health purposes subsequent to the initial transport. 

(a)

 When an individual is in the care of a
 facility, the facility may determine the manner of non-emergency transport
 required for purposes of treatment of an individual. It may request the
 appropriate county governing body to provide such transportation. If the
 facility arranges on its own for such transportation to be accomplished by a
 party other than the Sheriff of the appropriate county, the county shall not be
 billed, and the facility may bill the individual. 

(b)

 In non-emergency situations, no female
 shall be transported without another female being in attendance unless the
 person transporting the female is the female's husband, father, adult brother,
 or adult son, as required by O.C.G.A. § 
37-3-101
 and O.C.G.A. § 
37-7-101
.

(17)

 The department shall by December 31,
 2021, develop and maintain policies that set forth the manner and frequency in
 which de-identified, aggregated data is reported to the department pursuant to
 O.C.G.A. § 
37-3-40
 and O.C.G.A. § 
37-7-40
.

(18)

 Failure to submit the information
 required by O.C.G.A. § 
37-3-40
 and O.C.G.A. § 
37-7-40
 shall result in the
 suspension of a facility's designation as an emergency receiving facility until
 the required reports are submitted to the department.

Rule 82-8-1-.04 Emergency Receiving Facility

(1)

 A private facility which has been
 designated as an emergency receiving facility shall comply with the regulations
 for hospitals set forth in Georgia Comp. R. & Regs. Chapter 111-8-40, as
 they now exist or as may be amended.

(2)

 The private facility shall arrange for
 the availability of a physician who will examine the patient as soon as
 possible, but in any event within 48 hours of admission.

(3)

 The private facility shall provide at
 least one seclusion room that conforms with the requirements of Georgia Comp.
 R. & Regs §.
 Every seclusion area shall be equipped with shatterproof windows and a locked
 door that can be opened from the outside, to accommodate individuals with
 reasonable safety, even if such equipment is not otherwise required by §.
 The facility must maintain the privacy of any individual in the seclusion room
 by minimizing that individual's visibility to other individuals being
 served.

(4)

 Every Crisis
 Stabilization Unit (CSU) shall follow the applicable DBHDD policies and
 applicable DBHDD Provider Manuals.

(5)

 Every private facility designated as an
 emergency receiving, evaluating, and/or treatment facility, and every CSU,
 shall follow generally accepted standards and consider best practices related
 to discharge planning.

Rule 82-8-1-.05 Evaluating Facility

(1)

 A private facility which has been
 designated as an evaluating facility shall comply with the regulations for
 hospitals set forth in Georgia Comp. R. & Regs. Chapter 111-8-40, as they
 now exist or as may be amended.

(2)

 The active medical staff of the private facility or the CSU shall include a
 physician who has completed at least one year of approved psychiatric
 residency. Additionally, the facility shall make available consultation by a
 psychiatrist as defined in Rule -.02 of this Chapter.

(3)

 The private facility or the CSU shall
 provide at least one seclusion room that conforms with the requirements of
 Georgia Comp. R. & Regs §.
 Every seclusion area shall be equipped with shatterproof windows and a locked
 door that can be opened from the outside, to accommodate individuals with
 reasonable safety, even if such equipment is not otherwise required by §.
 The facility must maintain the privacy of any individual in the seclusion room
 by minimizing that individual's visibility to other individuals being
 served.

(4)

 The private facility or
 the CSU shall utilize available resources in the community to provide
 psychological tests and social work services if such services are needed for
 the patients and do not exist within the facility. In utilizing such resources,
 the private facility or the CSU shall comply with the requirements of Georgia
 Comp. R. & Regs §; and, if that
 regulation or any other applicable law or regulation does not permit the
 utilization of such resource, then this paragraph shall not be construed as
 authorizing its utilization.

(5)

 Every Crisis Stabilization Unit (CSU) shall follow the applicable DBHDD
 policies and applicable DBHDD Provider Manuals.

(6)

 The private facility or the CSU shall
 follow generally accepted standards and consider best practices related to
 discharge planning.

Rule 82-8-1-.06 Treatment Facility

(1)

 A private facility which has been
 designated as a treatment facility shall comply with the regulations for
 hospitals set forth in Georgia Comp. R. & Regs. Chapter 111-8-40, as they
 now exist or as may be amended.

(2)

 The private facility shall have an identifiable program specifically designed
 for individuals with behavioral health challenges.

(3)

 The program described at (2) immediately
 above shall be directed by a psychiatrist employed or contracted by the private
 facility.

(4)

 The services provided
 by a private facility shall include, at a minimum, psychological services,
 social services, activity therapies, and rehabilitation services.

(5)

 The private facility shall follow
 generally accepted standards and consider best practices related to discharge
 planning.

Rule 82-8-1-.07 Enforcement

(1)

 The administration and enforcement of
 these rules and regulations shall be as prescribed in Chapter 1, Chapter 3, and
 Chapter 7 of Title 37 of the Official Code of Georgia Annotated.

(2)

 If DBHDD determines that a facility has
 violated one or more of the regulations in this Chapter, or has failed to
 comply with one or more DBHDD standards applicable to the facility, or has
 failed to comply with the terms of any contract or agreement the facility has
 with DBHDD, then, in addition to any other remedies available by law, DBHDD may
 enforce the regulations, standards, or contract or agreement by actions which
 may include: 

(a)

 issuing a time-limited
 designation or designations to the facility;

(b)

 temporarily suspending a designation or
 designations of the facility; 

(c)

 removing a designation or designations of the facility.

(3)

 DBHDD shall give written notice of any of
 the actions specified at paragraph (B) above to the facility. Such notice shall
 clearly state the action being taken, the reason for the action, the duration
 of the action (provided, however, that the removal of a designation shall be
 understood to be permanent unless otherwise expressly stated in the notice).
 Such notice shall also contain information sufficient to allow a facility to
 exercise its rights under this Rule.

(4)

 If DBHDD gives written notice as
 described in paragraph (C) of this Rule, and if the facility has not consented
 to the action described in the notice, then such action shall be subject to the
 provisions of Chapter 13 of Title 50 of the Official Code of Georgia Annotated,
 the Georgia Administrative Procedure Act. Any request for a hearing in response
 to such action shall be in writing and must be submitted to DBHDD no later than
 10 calendar days from the date of receipt of the written notice from DBHDD. If
 DBHDD transmits the written notice via electronic mail (e-mail), the written
 notice shall be deemed received by its addressee on the date on which it was
 sent. The written notice from DBHDD to impose an enforcement action upon any
 Emergency Receiving, Evaluating, or Treatment Facility shall include the
 address to which a request for a hearing must be directed.

(5)

 Any request for a hearing submitted
 pursuant to paragraph D shall comply with the following: 

(a)

 If DBHDD's written notice states that the
 revocation or suspension is based on one or more specific findings that the
 facility violated a state or federal law, these regulations, and/or DBHDD
 policies and standards, then the request for hearing shall state each finding
 that the facility wishes to contest at the hearing; and shall also state
 whether the facility disputes (i) the factual basis of the finding; (ii)
 DBHDD's determination that the facility violated the law, regulation, or policy
 or standard; or (iii) both.

(b)

 If,
 pursuant to subparagraph (a) immediately above, the facility disputes the
 factual basis of a finding, then the hearing request shall include a statement
 explaining why the facility believes the factual basis is untrue.

(c)

 The hearing request must be sent to DBHDD
 at the address listed in the written notice to impose an enforcement
 action.

(d)

 When DBHDD receives a
 hearing request in accordance with this regulation, DBHDD shall transmit the
 hearing request to the Office of State Administrative Hearings in accordance
 with the Georgia Administrative Procedures Act and shall otherwise comply with
 that Act.

Rule 82-8-1-.08 Severability

In the event that any rule, sentence, clause or phrase of any
 of the rules and regulations in this Chapter 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 82-8-1-.01 Authority
Rule 82-8-1-.02 Definitions
Rule 82-8-1-.03 Designation as Emergency Receiving, Evaluating and Treatment Facilities
Rule 82-8-1-.04 Emergency Receiving Facility
Rule 82-8-1-.05 Evaluating Facility
Rule 82-8-1-.06 Treatment Facility
Rule 82-8-1-.07 Enforcement
Rule 82-8-1-.08 Severability