Update: The Future of Certificate of Need
One of the more integral functions of the time we spend preparing for our legislative session is the meeting of our task forces. Task forces have proven to be a vital part of crafting legislation in focus areas that we deem to need more attention than we can offer them in a traditional committee. One of these areas being Kentucky’s Certificate of Need program.
This task force has been busy reviewing the regulations that surround our certificate of need program in the state. Legislators created the panel to target issues pertaining to certificates of need. The certificate of need requirement has long been a point of discussion among lawmakers considering how to improve access to quality health care. A certificate of need (CON) is a government-mandated permission slip that is required before a firm can enter certain industries that involves a complicated 9 step process to apply for a CON.
The process behind these documents came to fruition in the 1960’s with the stated purpose being to improve the quality and access to healthcare facilities, services and providers to create a cost-efficient healthcare delivery system. Some form of certificate of need requirement exists in more than 30 other states today. While it was designed to ensure access to affordable care, CON opponents believe the government’s intervention is eliminating competition that could improve the delivery of care. Lawmakers have grappled with the issue for several decades, and this year’s task force began as a result of discussion during the 2023 Regular Session.
Through the interim, the Certificate of Need Task Force has heard from stakeholders in the healthcare industry both for and against the regulations in place. There have been crucial conversations surrounding this topic and debate has been passionate at times. Some experts claim that Kentucky’s Certificate of Need program is much too comprehensive, citing that our neighbors in Ohio deal with 1 CON restriction while Kentucky has a requirement for 32 services and technologies. Because of the strain COVID-19 had on the healthcare system as a whole, there has been a nationwide push to repeal stringent Certificate of Need programs. Other states are finding that after repeal, healthcare access was enhanced. For example, South Carolina repealed all of their Certificate of Need requirements for their health services, except for Long Term Care facilities. Additionally, Indiana has reduced their CON program to 1 requirement for long term care facilities, similar to the regulations in Ohio.
Most notably, however, is the claim that Certificates of Need delay and hinder both the access, cost, and quality of care available across the state. For example, because of CON laws, rural hospitals can’t reallocate beds, buy new equipment, or add needed services without going through an application process and as one meeting of the task force foretold, 65% of studies find that CON is associated with higher prices.
CON has also been noted as a contributing factor in why certain areas of the state have fewer options to receive care. An example of this would be the limiting of Free-Standing Birthing Centers in the state, as 37 states in the nation of not require a Certificate of Need for them. The process denied an application for a Birthing Center of this nature in 2012, and we have not seen an application for one since.
While there is no clear-cut solution to correcting the issues that are prevalent in our hospitals and healthcare system, the legislature’s commitment to supply our citizens with access to quality care is unwavering. I fully anticipate there being even more conversations surrounding Certificates of Need in our state as we begin to outline our priorities for the 2024 Legislative Session, as this task force is set to release its findings and recommendations in the weeks to come.
Earlier this month, I was excited to attend the ground breaking ceremony for the Cincinnati Children’s Brandon and Kelly Janszen Union Building. Once the facility is completed in the spring of 2025, it will deliver a combination of pediatric primary care services and some specialty care. While not a full-service hospital, it is one step closer to being able to provide services to our most vulnerable children without having to leave the state.