Lawmakers float health care regulatory overhaul

Published 1:58 pm Thursday, February 7, 2019

ATLANTA – A proposal that would make sweeping reforms to the state’s system for regulating health care facilities – while clearing a path for a possible Medicaid waiver application – has been filed at the Statehouse.

The certificate-of-need program, commonly referred to as just CON, has been used in Georgia for decades as a way to try to measure the need for health care services while guaranteeing access to those services and controlling costs.

But critics say the program has turned hospitals into monopolies, squashing the free market forces that would encourage competition and help drive down prices for patients.

The Trump administration has also encouraged states with certificate-of-need programs to scale them back, or eliminate them altogether. Because of that, some under the Gold Dome say they see curtailing Georgia’s regulations as a prerequisite for pursuing a Medicaid waiver.

Gov. Brian Kemp has proposed spending $1 million on exploring a waiver that would give Georgia more flexibility in how it uses its federal Medicaid dollars. And although it is still unclear what a waiver in Georgia might look like, there is growing support for the concept.

“I think the electorate sent all of us a message: Do something about health care and do it now,” said Sen. Matt Brass, a Republican from Newnan who is carrying the bill in the Senate, referring to last year’s election.

“Medicaid waivers are obviously now a bipartisan issue. You couldn’t have said that maybe a year ago. Again, with the electorate sending that message, I think we heard it loud and clear,” he said. “And in order to get the waivers, some CON reforms are going to need to take place.”

The 83-page bill would throw out the controversial program, which often mires providers in a costly and time-consuming process, and replace it with a licensing program that would preserve some remnants of the old program. For example, hospitals outside of metro Atlanta could still object to a new similar facility trying to set up shop within 10 miles.

The measure would also beef up transparency requirements, such as requiring public tax documents to be posted online, and ban the practice of buying up “medical use rights” on nearby property as a way to snuff out potential competition.

It would also compel providers to provide a certain amount of care to the poor. If facilities miss the mark, they will have to pay a fine into the state’s indigent care trust fund, which supports rural health care and the state’s insurance program for the poor and disabled.

The goal, Brass said, is to discourage larger hospitals in more affluent areas from luring insured patients away from other areas within state. Hopefully, he said, those insured patients would stay closer to home for care, driving down the high percentage of indigent care seen at some rural hospitals.

The measure is also expected to boost funding for the state’s indigent care trust fund, although it is not clear right now by how much.

“That’s not the goal, but if it does, then that money goes to helping those who need help paying for health care,” said Rep. Matt Hatchett, a Republican from Dublin who is sponsoring the bill in the House.

“That’s not the goal but, along with the transparency, it’s making our hospitals accountable for doing what they’re supposed to be doing and benefiting the communities they’re in because they’re nonprofits,” he said.

Under the proposal, the state would also no longer limit the number of in-state patients the Cancer Treatment Centers of America is allowed to treat at its Newnan campus, which has long been a source of contention.

Lawmakers are also offering some perks in the proposal: Adding $40 million to the rural hospital tax credit, which is now capped at $60 million, and ditching the need for state approval for equipment upgrades, such as a new MRI machine, that currently comes with the certificate-of-need program.

“They can make a business decision whether to do it or not,” Hatchett said. “They won’t have to apply for this, that or the other.”

Many of the proposed changes come out of the Rural House Development Council, which was started two years ago at the behest of House Speaker David Ralston.