Effort To Change Georgia’s CON Laws Gains More Momentum

Following a similar move by a House panel, a Georgia Senate study committee has proposed some major changes in the state’s health care regulatory structure known as certificate of need (CON).

The panel, chaired by state Sen. Ben Watson, R-Savannah, a physician, has formulated draft legislation that could ease restrictions involving Cancer Treatment Centers of America, which has a hospital in Newnan, and clear a path for a planned sports medicine center in Alpharetta.

The proposed Senate revisions take ‘‘a more moderate approach’’ to CON reform than the House plan, Watson said at a committee hearing Friday. The goal, he said, is deregulation – to inject more competition into health care services.

A House panel earlier this month backed more sweeping changes to CON. The influential House Rural Development Council announced recommendations for legislation in the upcoming General Assembly session that include replacing CON with an accreditation and “rigorous licensing system’’ for health care providers.

The proposals of each committee come at the same time the Trump administration is urging states to consider scaling back or repealing their CON laws, and is pushing back against hospital consolidation. And the committee work appears to set up a major legislative battle over health care regulations in the 2019 General Assembly session, which will begin in January.

The CON process governs the construction and expansion of health care facilities and services in the state. A provider must obtain a “certificate of need” to proceed with such a project, and an application for a CON can be challenged by competitors or other interested parties.

Health care regulatory decisions have a big impact on communities and businesses. Hospital groups have been strong defenders of the current CON system in Georgia, constantly opposing any legislative efforts to change it.

The Senate-proposed provisions would provide exemptions from CON review for:

• Medical equipment purchases and most imaging services.
• Mental health and substance abuse facilities.
• Hospitals adding cardiac services, under certain conditions.

It would also allow some multi-specialty doctor groups to operate surgery centers focusing on one specialty. And the draft bill would ease restrictions on the ability of a hospital to expand its bed capacity.

The legislation, if enacted, could help Cancer Treatment Centers of America to expand its capacity and serve more Georgia patients at its Newnan facility, which is the national chain’s center for the Southeast.

CTCA has pushed such legislation at the General Assembly, but has run into strong opposition from other hospitals. The Senate proposal would require CTCA to provide uncompensated indigent or charity care that meets or exceeds 5 percent of the hospital’s adjusted gross revenues, and to provide care to Medicaid beneficiaries.

A proposed sports medicine center in Alpharetta may also gain a route to state approval under the Senate initiative.

Rural areas would get special protections against certain CON changes, just as the House Council has proposed.

Both the Georgia Hospital Association and the Georgia Alliance of Community Hospitals voiced concern about the Senate plan.

Ethan James of the GHA told the Senate panel Friday that CON “preserves access [to care] for all Georgians. CON, at its core, is about the uninsured.”

And the Alliance of Community Hospitals said the current arrangement protects patient safety and preserves quality standards in medical care.

Fifteen states have repealed their certificate-of-need laws. Among the states that still have such laws, Georgia has one of the most restrictive CON systems, the Rural Development Council was told recently at a Statesboro meeting.

Andy Miller is editor and CEO of Georgia Health News