Certificate Of Need Change Moves On, With A Twist
Grappling with an issue that is a priority of House leaders, a Senate committee Monday stopped short of supporting the full repeal of a controversial regulatory process that helps determine whether new hospitals can be built.
House leaders throughout the past year have sought to eliminate the decades-old "certificate of need" approval process for new and expanded hospitals.
But the Senate Health Policy Committee on Monday approved a bill (SB 1144) that would instead allow exemptions to the so-called CON process on the condition that health facilities provide enough care to low-income and uninsured patients. Also --- in a twist that could make the proposal harder to pass politically --- the Senate bill would apply to facilities such as nursing homes and hospice providers, along with hospitals.
"The bill simply says that if you want to be exempt from a certificate of need, you have to provide as much or more charity care as anybody else in the market,'' said Sen. Don Gaetz, a Niceville Republican who is sponsoring the bill.
Certificates of need have long been a contentious issue and regularly touch off legal battles about whether new hospitals and other facilities should be allowed. House Republican leaders argue that eliminating the process will lead to more competition in the hospital industry and provide more choices to patients. A bill to eliminate the process (HB 437) for hospitals is ready to go to the House floor.
But major players in the hospital industry, including the Florida Hospital Association and the Safety Net Hospital Alliance of Florida, oppose revamping the system.
The Safety Net Hospital Alliance, for example, represents public, teaching and children's hospitals that provide special services such as trauma care and burn units. The alliance argues that eliminating the CON process could lead to new hospitals being built that would draw away paying patients from safety-net hospitals. The alliance contends that would make it harder financially for the safety-net hospitals to provide special services, along with caring for large numbers of indigent patients.
Attorneys for the two hospital groups Monday opposed Gaetz' bill, which was approved by the Health Policy Committee in a 6-3 vote.
"It is a very artful attempt to address the deregulation of CON if it must be deregulated,'' said Mark Delegal, general counsel of the Safety Net Hospital Alliance. "But we would stand and ask you not to deregulate CON and to leave it as it is as far as a regulation."
Gaetz' proposal to bring nursing homes and hospice providers into the debate could make the issue even trickier politically, with the bill drawing opposition Monday from groups representing those industries.
To receive exemptions from the CON process under Gaetz' bill, heath-care providers would have to agree to meet requirements for charity care. After projects begin operating, they would initially make payments to a state trust fund and later would have to provide at least the average amount of charity care for facilities in the same areas.
Gaetz said the bill would prevent new facilities from being able to "cherry pick" only the most-profitable patients and services.
"This bill provides for more choice for health-care consumers and ensures that anyone who wants to build a new hospital, new rehab beds, start a new hospice, develop a new nursing home can be exempt from CON only if they provide as much or more charity care as the other providers of the same service in the same area,'' Gaetz said.
But the bill drew opposition from the three Democrats on the Senate panel.
"I'm just concerned that it is going to have a dramatic effect on the safety-net hospitals,'' Senate Minority Leader Arthenia Joyner, D-Tampa, said.