Tallahassee Bill 21 fuels speculation about future growth of hospitals


A bill passed by the House and Senate April 29 is heading to the Governor’s office for his signature and will help pave the way for hospitals to get built and start providing care to patients a whole faster.

Almost lost in a sweeping legislative session with controversial agenda items such as recreational marijuana, sanctuary cities and an education bill that would allow armed teachers generating headlines.

H.B. 21 is a health care reform bill that eliminates the state approval process for most new “general” hospitals, known as a Certificate of Need (CON.) The bill will also remove CONS process for specialty hospitals in two years. With the elimination of the CON process, hospitals may be developed much faster and makes land suitable for hospital development very attractive.

Supporters of repealing CON oversight, including many free-marketers cite Increased competition, decreased red tape, lower prices and improved access for Florida patients. Detractors of the repeal worry new facilities could lower health care quality, particularly for complex procedures such as heart transplants.

CONs are issued in Florida by the Agency for Health Care Administration (AHCA)to build new facilities or to add new services.

Recent research by Thomas Stratmann and Jacob Russ demonstrates that there is no relationship between CON programs and increased access to health care for the poor. There are, however, serious consequences for continuing to enforce CON regulations. In particular, for residents of Miami-Dade County (Florida’s most populous county), these programs result in approximately 3,428 fewer hospital beds, between 5 and 10 fewer hospitals offering magnetic resonance imaging (MRI) services, and 18 fewer hospitals offering computed tomography (CT) scans. For those seeking quality health care throughout Florida, this means less competition and fewer choices, without increased access to care for the poor… for more information, click here. (https://www.mercatus.org/system/files/Koopman-Certificate-of-NeedFL-MOP.pdf)

The repeal measure, which takes effect July 1 does not completely deregulate the CON process. Nursing homes, hospice and care facilities for the developmentally disabled must still submit to CON requirements. However,new hospitals and hospitals seeking expansion will have a much easier time obtaining approval and will be able to build much faster.

Two examples of Florida hospitals seeking expansion are Largo Medical Center in Pinellas County and Baptist Medical Center Jacksonville. Both recently notified the state that they seek CONs for new transplant programs: Baptist Medical Center applied for a CON to establish an adult bone-marrow transplant program. Largo Medical Center sought to establish an adult heart-transplant program.

The longstanding CON law is still regulated in 35 states. Those regulating health care through a CON program are ranked based on restrictions to entry, expansion and competition.

Before H.B 21 was signed into law, Florida ranked 22nd out of 35 states for the number of CON laws, according to 2016 data compiled by the Mercutus Center from state laws, agencies and regulators. Florida was also among five states that saw the biggest increase in covered CON laws since 2011, the report said.

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