Premier Health Care Investments, LLC v. Uhs of Anchor, L.P
310 Ga. 32
| Ga. | 2020Background
- In 2005 the Georgia Department of Community Health (DCH) adopted the “Psychiatric Rule,” requiring a Certificate of Need (CON) for the establishment or “expansion” (defined as adding beds) of acute adult psychiatric/substance‑abuse inpatient programs.
- Premier/Flint River Hospital held a general CON for 49 beds and a separate CON authorizing a 12‑bed psychiatric program, but had internally redistributed beds and operated up to 30 psych/substance‑abuse beds while staying within the 49‑bed licensed total.
- A competing provider complained in 2016; DCH issued a cease‑and‑desist enforcing the Psychiatric Rule. An administrative hearing officer upheld the cease‑and‑desist; the DCH Commissioner reversed; Fulton Superior Court affirmed the Commissioner.
- The Court of Appeals reversed, concluding OCGA § 31‑6‑40(a)’s list of “new institutional health services” is non‑exclusive and that DCH could require a CON for the psychiatric bed expansion under its rulemaking authority.
- The Georgia Supreme Court granted certiorari and reversed the Court of Appeals: it held OCGA § 31‑6‑40(a) is an exhaustive list and the Psychiatric Rule cannot require a CON for intra‑facility bed redistribution that does not increase total licensed beds; to the extent the Rule purported to do so it exceeded DCH authority.
Issues
| Issue | Plaintiff's Argument (Flint River) | Defendant's Argument (DCH / Southern Crescent) | Held |
|---|---|---|---|
| Whether DCH may add by rule a category of “new institutional health service” (bed redistribution) requiring CON beyond OCGA § 31‑6‑40(a) | DCH lacks authority; only General Assembly can expand the statutory list | DCH may promulgate rules implementing the CON scheme and thus may add such categories | No — OCGA § 31‑6‑40(a) is exhaustive; DCH may not add bed‑redistribution as a CON trigger |
| Meaning of “include” in OCGA § 31‑6‑40(a): exclusive vs. illustrative list | “Include” introduces an exhaustive, limiting list of services requiring CON | The list is non‑exclusive; DCH has power to supplement by rule | “Include” is limiting here; list is exhaustive |
| Whether OCGA § 31‑6‑41(a) (CON “scope”) requires a new CON when a hospital reallocates beds within its licensed total | Reallocation within licensed capacity does not create a new institutional health service requiring a separate CON | Exceeding a CON’s authorized beds exceeds its scope and thus requires CON approval | § 31‑6‑41(a) does not override § 31‑6‑40(a); reallocation within total licensed beds does not by itself require new CON |
| Constitutional/delegation concerns: would allowing rulemaking power to expand § 31‑6‑40(a) violate separation/non‑delegation? | Allowing DCH to expand the statutory list by rule would raise serious non‑delegation/separation‑of‑powers problems | DCH’s broad rulemaking authority under OCGA § 31‑6‑21 justifies the Rule | Court: expansion by rule would raise serious non‑delegation doubts; interpret statute narrowly to avoid constitutional problem (concurring justices said the constitutional discussion was unnecessary to decide the case) |
Key Cases Cited
- UHS of Anchor, L.P. v. Dept. of Community Health, 351 Ga. App. 29 (2019) (Court of Appeals held the Psychiatric Rule valid and § 31‑6‑40(a) non‑exclusive; reversed here)
- Berryhill v. Ga. Community Support & Solutions, Inc., 281 Ga. 439 (2006) (treated “includes” as limiting when followed by detailed specific phrases)
- Wetzel v. State, 298 Ga. 20 (2015) (construed “including” expansively in a different statutory context)
- HCA Health Svcs. of Ga., Inc. v. Roach, 265 Ga. 501 (1995) (invalidated an agency rule as an unlawful delegation/usurpation of legislative power in the CON context)
- North Fulton Med. Ctr. v. Stephenson, 269 Ga. 540 (1998) (invalidated agency rule exempting facilities from CON requirements as unconstitutional delegation)
- Pruitt Corp. v. Ga. Dept. of Community Health, 284 Ga. 158 (2008) (standard of review for administrative factual findings and legal conclusions)
- City of Guyton v. Barrow, 305 Ga. 799 (2019) (limits to judicial deference to agencies where statutory text is unambiguous)