The state of CON repeal in Georgia

With only five legislative days remaining in the 2024 General Assembly, how are things looking for the effort to reduce Certificate of Need (CON) laws in Georgia? 

Repealing CON laws, in which the government is allowed to determine whether new healthcare facilities or service lines are allowed to open, remains one of the more contentious political debates. Pairing this discussion in recent months with the potential of Medicaid expansion has done little to lessen the intensity.

Incumbent providers in any business sector typically fight like hell to maintain the status quo. It just so happens that most corporations with hundreds of millions of dollars in annual profit are not government protected monopolies. Nor do most oil companies or tech giants – to borrow favored boogeymen of both the left and right – enjoy non-profit status, or possess financially struggling independent operators they can put forth in a political debate. 

This year both the House and Senate introduced bills to reduce the burden of CON laws by varying degrees. This came after both chambers completed study committees on the issue in 2023.

The primary bill for this effort quickly centered on HB 1339, a bill sponsored by Rep. Butch Parrish, R-Swainsboro, Chairman of the House Study Committee on CON Modernization and the House Rules Committee, which determines which bills make it to the House floor for a vote. The bill also featured House Speaker Jon Burns, R-Newington, as the second sponsor. The high profile status of the bill’s sponsors did not go unnoticed during committee debate in both chambers on this legislation.  

The House bill sought to modernize the CON program in multiple ways, primarily by easing the process for hospitals. The window for reopening closed hospitals would be extended from 12 to 24 months, hospital beds could be transferred from one facility to another within the same system and a limited number of hospital beds could be added without requiring a CON. 

New rural hospitals would be allowed to open without a CON, as long as they receive and maintain a trauma center designation within 30 months of opening, serve as a teaching hospital for residents and provide psychiatric and behavioral health services. Additionally, basic obstetric services could be offered by hospitals in rural counties. 

The House also emphasized increased access to mental health services, eliminating the CON requirement for psychiatric or substance abuse inpatient programs and beds. Capital expenditure limitations – which are set annually by the Department of Community Health – were also eliminated. 

However, the bill wasn’t all just CON reform. The statewide cap on the rural hospital tax credit program was increased from $75 to $100 million. Perhaps the most covered aspect in the bill is the establishment of the Comprehensive Health Coverage Commission to explore potential paths forward for Medicaid expansion in the state.

The bill overwhelmingly passed the House, with only one “no” vote. 

Senate Regulated Industries Chairman Bill Cowsert, R-Athens, was the lead sponsor of the bill in the Senate. He did an admirable job navigating not only the competing healthcare interests, but the interchamber dynamics that ordinarily rise between the House and the Senate during this time in the session. 

While the Senate version maintains most of the original language, additional CON requirements were also eliminated. Cardiology was added to the list of services allowed in single-specialty outpatient surgery centers that do not require a CON. This reflects the advancements in safety and technology for procedures like cardiac catheterization, vascular surgery and interventional radiology.

Notably, the amended bill allows physicians of different specialties to practice in an outpatient surgery center – but still only allows for one group of physicians to perform surgeries there. For example, both pediatricians and OB/GYNs could have office space in the surgery center, but only the OB/GYNs would be allowed to perform surgery there. 

The Senate version also contains an exemption that would allow the Morehouse School of Medicine to move forward with building a general hospital to help fill the healthcare void left by the closure of Atlanta Medical Center. The CON requirement for birth centers was eliminated as well, an issue the Foundation has long highlighted.

However, the CON exemptions for these new facilities and services came with qualifications in both bills: while the House favored a 5% minimum of adjusted gross revenue to serve indigent and charity care, the Senate favored an approach by which the minimum would be determined by the Department of Community Health.

The bill passed the Senate by a bipartisan vote of 43-11.  

Meanwhile, opponents of this legislation have adopted their traditional “no quarter” approach, claiming that the slightest opening in CON will lead to a massive wave of rural hospitals closing. Despite Georgia being one of the most heavily regulated states in the country when it comes to CON, in the past fifteen years nine rural hospitals have closed; and at least 12 rural hospitals no longer have a labor & delivery unit. 

While the two versions of the bill share a lot of similarities, there is an acceptance at the capitol that what differences exist will have to be hashed out in a conference committee. This is a process in which three legislators from each chamber negotiate a final version for both the House and Senate to vote on. 

Hopefully it results in an outcome that increases healthcare access for all Georgians.  

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