Calls Intensify for Repeal of Florida’s Health-Care Provider ‘Certificate of Need’ Process

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The House Heath Market Reform Subcommittee unanimously passed a proposed repeal of Florida’s certificate-of-need review program, which critics say allows hospitals, nursing homes and other health care providers to restrict patients’ access to competitively-priced medical services.

House Bill 21, sponsored by Rep. Heather Fitzenhagen, R-Fort Myers, was approved in a 14-0 vote Thursday. It next goes before the House Health Care Appropriations Subcommittee and Health & Human Services Committee.

A similar Senate bill, SB 1712, sponsored by Sen. Gayle Harrell, R-Stuart, was filed March 1 but has not been assigned to committees yet.

Florida is one of 35 states that has adopted a Certificate of Need (CON) process to regulate the expansion of health care facilities to avoid the duplication of medical services within specific markets or areas.

The process requires hospitals, nursing homes and other health care providers to demonstrate a "need" exists before expanding or offering new services.

Florida’s CON process governs new facility construction, new specialized hospital services, such as trauma services, and the number of inpatient beds at hospitals.

Supporters maintain the review process ensures health services are available statewide. Without CONs, proponents say, hospitals in more populated, affluent areas would expand while those in rural areas would be further imperiled, reducing access for many people.

CON opponents argue that getting rid of the state’s CON process would encourage greater supply, competition and access, which would lower health care costs.

A 2016 study by the Mercatus Center at George Mason University maintains that eliminating Florida’s CON laws "would decrease costs, increase access to care, and improve quality in the form of lower mortality rates and fewer post-surgery complications."

Adopted in 1973, Florida’s CON process has been amended twice. In 2008, the Legislature removed financial viability and cost criteria from the review, focusing it solely on need and access to services.

Last year, the House passed HB 27, which removed hospitals from the CON process. In the upper chamber, however, the bill never made it out committee for a Senate vote.

Americans for Prosperity-Florida (AFP-F) urged the Senate to move on SB 1712 in a direct mail campaign targeting the Senate districts of members of the Health Policy Committee and Health & Human Services Appropriations Subcommittee, as well as Senate President Bill Galvano’s Bradenton district.

"CON laws protect entrenched interests at the expense of both health care providers and patients. The debate over how to fix health care should focus on how to make health care affordable, accessible and better," AFP-FL Director Skylar Zander said in a statement.

CON laws limit important health care services, prevent competition and stand in the way of increased access to health care, AFP-FL maintains.

The direct mail ads say, "It’s time to repeal certificate of need regulations" in a bold-faced font and ask recipients to call their lawmakers and ask them to support SB 1712.

"We hope the Senate takes up SB 1712 by Senator Gayle Harrell and that the House follows Speaker Jose Oliva’s lead in championing innovative policies to free health care providers to work and for patients to receive the care they need," Zander said.

The Florida Health Care Association (FHCA) on Monday cited defeating HB 21 and SB 1712 among its top legislative priorities for the 2019 session.

FHCA lobbyist Bob Asztalos said the organization fears repealing the CON process would result in unmanaged growth in some areas of health care while leaving others to wither.

Its chief concern is nursing homes. With Florida’s nursing home-aged population projected to double by 2030, Asztalos said the FHCA would be neutral on the bills if nursing homes were exempted.

"We want people with the lower acuity to receive their care in the home," he said. "We want to take care of the higher acuity resident, and we think that our certificate of need process allows for that to happen and keeps us balanced."

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