Hospital regulatory changes revived in Senate

Fernandina Beach senator says bill, added protections are 'best of both worlds'

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TALLAHASSEE, Fla. – After rebuffing the legislation initially, a Senate panel gave approval Monday to a pared-back bill that would eliminate controversial regulations for Florida hospitals.

The Senate Health Policy Committee voted 9-1 to revamp the state’s “certificate of need” laws, which require regulators to determine that there is a “need” before certain new health-care services can be offered or new facilities can be built.

The bill (SB 1712) would maintain the regulations -- which are designed to manage the growth of health-care facilities -- for nursing homes, hospices and so-called “tertiary” services.

But it would eliminate the requirement that the state sign off on hospital construction, so long as the new hospitals have at least 100 beds and agree to meet minimum charity-care requirements. The new hospitals also would have to accept Medicare and Medicaid patients.

“This is not your parents’ CON repeal bill,” said Sen. Aaron Bean, R-Fernandina Beach.

But the Senate bill doesn’t have enough protections to assuage the fears of Elaine Thompson, president and chief executive officer of Lakeland Regional Health.

Critics of eliminating the certificate of need program argue, in part, that a repeal could lead to new hospitals drawing insured patients from older facilities, some of which provide costly specialized services.

Thompson said her hospital, located in Polk County, offers safety-net services for the poor and uninsured. Also, for example, the facility has the only comprehensive care stroke program in the county and provides a high-risk obstetrics program.

Thompson said 76 percent of the hospital’s caseload is paid by government programs, either Medicaid or Medicare, and the payments are “fixed.” Just 24 percent of the patient caseload is commercially insured patients.

“If any of this commercial payment volume was to leave this under-served community, our ability to keep those big safety-net programs there for the community would really (be at risk),” she said.

Elimination of certificate of need regulations has been a top priority of House Speaker Jose Oliva, a Miami Lakes Republican who argues the state should take more of a free-market approach to health care. The House moved quickly to pass a bill to eliminate the program.

But the proposal has run into resistance in the Senate.

Senate Health Policy Chairwoman Gayle Harrell, a Stuart Republican sponsoring the Senate version, was forced last month to table her bill, in part, because of concerns from Bean and Sen. Ed Hooper, R-Clearwater.

But Bean on Monday said the bill and the added protections are the “best of both worlds.” While lessening some restrictions, the revised version would preclude the development of so-called “boutique hospitals” that some fear would cherry-pick paying customers from existing hospitals.

The Senate legislation, however, is now drastically different from the version passed by the House.

That bill (HB 21) would eliminate the certificate of need program in its entirety, including regulations for nursing homes, hospices and tertiary services such as burn units, neonatal intensive care centers and transplant programs.

Sen. Janet Cruz, R-Tampa, was the only no vote on the bill Monday in the Senate committee. But it wasn’t because she opposed the measure. Cruz thanked Harrell for working hard on a proposal that ultimately was supported by traditional opponents of eliminating the CON program, including Jackson Memorial Hospital and UF Health Shands in Gainesville, two major safety-net providers.

But Cruz said she had reservations about moving the bill along because she feared what would occur in negotiations between the House and Senate.

“I know the goal is to get this bill out of committee, but I worry about what the House is doing,” she said.

 “I’m not confident that this version will remain as we are voting for it now,” she said.

Sen. Darryl Rouson, D-St. Petersburg, said he would support the measure but added that “it’s not without reservations.”

Rouson urged his fellow Democrats on the Senate Health Policy Committee to support the bill. The move, he said would send a “strong message to the House and the rest of the Senate in the next two committees that we prefer this version.”