A certificate of need (CON), in the United States, is a legal document required in many states and some federal jurisdictions before proposed creations, acquisitions, or expansions of healthcare facilities are allowed. CONs are issued by a federal or state regulatory agency with authority over an area to affirm that the plan is required to fulfill the needs of a community.
CONs have been criticized for granting monopoly privileges to existing hospitals and healthcare facilities, thereby driving down the number of hospitals and hospital beds in a community. One study found that CON laws resulted in 50% fewer hospitals per 100,000 persons, and 12% fewer beds at the typical hospital. CONs have been blamed for the shortage of hospital beds during the COVID-19 pandemic in the United States.
The concept of the CON first arose in the field of health care and was passed first in New York in 1964 and then into federal law during the Richard Nixon administration in 1974, with the passage of the National Health Planning and Resources Development Act. [1] [2] [3] Certificates of need are necessary for the construction of medical facilities in 35 states and are issued by state health care agencies:
The certificate-of-need requirement was originally based on state law. New York passed the first certificate-of-need law in 1964, the Metcalf–McCloskey Act. From that time to the passage of Section 1122 of the Social Security Act in 1972, another 18 states passed certificate-of-need legislation. Section 1122 was enacted because many states resisted any form of regulation dealing with health facilities and services. [4]
A number of factors spurred states to require CONs in the healthcare industry. Chief among these was the concern that the construction of excess hospital capacity would cause competitors in an oversaturated field to cover the costs of a diluted patient pool by overcharging, or by convincing patients to accept hospitalization unnecessarily. [5]
In some instances where state and federal authorities overlap, federal regulations may defer authority from the federal agency to the state agency with concurrent authority as to the issuance of a certificate of need. However, deferment of this authority is not required. For example, the Department of Housing and Urban Development (HUD) issued the following determination:
HUD conducts the same analysis of need whether or not the state has a CON process. There is wide variation in the methods CON states use to decide whether or not to issue a certificate. HUD believes that the Act's required need assessment is best performed using a method that is applied consistently to hospitals in all states. Should the state's CON process and HUD's assessment of need reach differing conclusions on the need for a proposed project, HUD will review the case closely to determine if its conclusion should be changed. [6]
CONs are sometimes sold in bankruptcy as an asset, [7] and the CON requirement is sometimes used by competitors to block the reopening of existing hospitals. [8] In June 2023, a Tennessee administrative law judge blocked the opening of a new hospital in Rutherford County by Vanderbilt University. The state had initially approved the hospital and granted it a certificate of need. But three existing providers intervened, claiming that there was not a need for another facility in the area. [9] The 42-bed hospital has been in the works since 2020, with a tentative opening in 2026, if not for the existing providers' objection to the new facility's construction.
In 2018, the Department of Health and Human Services recommended that states repeal their CON laws because they are a significant reason for increasing medical costs, and they reduce patients' healthcare choices. [10]
In June 2019, Florida Governor Ron DeSantis signed House Bill 21 into law, eliminating major portions of Florida’s CON program for hospitals, rehabilitation beds and hospital services, thereby removing many legal barriers to the expansion of health care services across Florida. [10] In May 2023, South Carolina Governor Henry McMaster signed into law the repeal of certificate of need laws in the state. [11]
Since new hospitals cannot be constructed without proving a "need", the certificate-of-need system grants monopoly privileges to already existing hospitals. Consequently, Alaska House of Representatives member Bob Lynn has argued that the true motivation behind certificate-of-need legislation is that "large hospitals are... trying to make money by eliminating competition" under the pretext of using monopoly profits to provide better patient care. [12] A 2011 study found that CONs "reduce the number of beds at the typical hospital by 12 percent, on average, and the number of hospitals per 100,000 persons by 48 percent. These reductions ultimately lead urban hospital CEOs in states with CON laws to extract economic rents of $91,000 annually". [13]
In 2019, after being lobbied by Michigan's largest hospitals, the state's Certificate of Need Commission attempted to restrict the availability of CAR T-cell cancer therapy to only the largest (predominantly urban) hospitals by classifying CAR T-cell therapy a "new" provision of healthcare that required CON certification, until the legislature overrode the commission. [14] [15] Some political advocacy organizations have blamed CONs for the shortage of hospital beds during the COVID-19 pandemic in the United States. [16]
In 2020, residents of Kentucky seeking to open a new home care agency specifically for Nepali immigrants were denied a certificate of need by the state. The residents challenged the decision in federal court and ultimately, the Sixth Circuit Court of Appeals affirmed a trial court determination that the state's CON law was constitutional. In the summer of 2022, the residents filed a cert petition with the United States Supreme Court, arguing that the Fourteenth Amendment requires more meaningful review of restrictions on the right to engage in a common occupation than the current rational basis standard. [17] [18] [19]
Home care is supportive care provided in the home. Care may be provided by licensed healthcare professionals who provide medical treatment needs or by professional caregivers who provide daily assistance to ensure the activities of daily living (ADLs) are met. In-home medical care is often and more accurately referred to as home health care or formal care. Home health care is different non-medical care, custodial care, or private-duty care which refers to assistance and services provided by persons who are not nurses, doctors, or other licensed medical personnel. For patients recovering from surgery or illness, home care may include rehabilitative therapies. For terminally ill patients, home care may include hospice care.
The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was 271,660 in 2022.
The Health Insurance Portability and Accountability Act of 1996 is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996. It modernized the flow of healthcare information, stipulates how personally identifiable information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and addressed some limitations on healthcare insurance coverage. It generally prohibits healthcare providers and healthcare businesses, called covered entities, from disclosing protected information to anyone other than a patient and the patient's authorized representatives without their consent. With limited exceptions, it does not restrict patients from receiving information about themselves. It does not prohibit patients from voluntarily sharing their health information however they choose, nor does it require confidentiality where a patient discloses medical information to family members, friends, or other individuals not a part of a covered entity.
A nursing home is a facility for the residential care of older people, senior citizens, or disabled people. Nursing homes may also be referred to as care homes, skilled nursing facilities (SNF) or long-term care facilities. Often, these terms have slightly different meanings to indicate whether the institutions are public or private, and whether they provide mostly assisted living, or nursing care and emergency medical care. Nursing homes are used by people who do not need to be in a hospital, but cannot be cared for at home. The nursing home facility nurses have the responsibilities of caring for the patients' medical needs and also the responsibility of being in charge of other employees, depending on their ranks. Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day.
Opened in 1962, the Albert B. Chandler Hospital along Rose Street at the University of Kentucky in Lexington, Kentucky is the flagship component of UK HealthCare. It is named for twice-former Governor of Kentucky A. B. "Happy" Chandler. The 945 bed medical facility features the Markey Cancer Center, the Kentucky Children's Hospital, the Gill Heart Institute, the Kentucky Neuroscience Institute and the Center for Advanced Surgery.
Disaster medicine is the area of medical specialization serving the dual areas of providing health care to disaster survivors and providing medically related disaster preparation, disaster planning, disaster response and disaster recovery leadership throughout the disaster life cycle. Disaster medicine specialists provide insight, guidance and expertise on the principles and practice of medicine both in the disaster impact area and healthcare evacuation receiving facilities to emergency management professionals, hospitals, healthcare facilities, communities and governments. The disaster medicine specialist is the liaison between and partner to the medical contingency planner, the emergency management professional, the incident command system, government and policy makers.
Navicent Health Baldwin, formerly known as Oconee Regional Medical Center, is a 140-bed hospital in Milledgeville, Georgia. It serves the three areas of Baldwin, Hancock, and Wilkinson counties.
Healthcare in Brazil is a constitutional right. It is provided by both private and government institutions. The Health Minister administers national health policy. Primary healthcare remains the responsibility of the federal government, elements of which are overseen by individual states. Public healthcare is provided to all Brazilian permanent residents and foreigners in Brazilian territory through the National Healthcare System, known as the Unified Health System. The SUS is universal and free for everyone.
Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965.
Healthcare in the United States is subject to far higher levels of spending than any other nation, measured both in per capita spending and as a percentage of GDP. Despite this, the country has significantly worse healthcare outcomes when compared to peer nations. The U.S. is the only developed nation without a system of universal healthcare, with a significant proportion of its population not carrying health insurance.
Benefis Health System is a nonprofit independent health care system based in the city of Great Falls in the state of Montana in the United States. The system owns 516-bed Benefis Hospital, Sletten Cancer Institute, Benefis Mercy Flight, 146-bed Benefis Extended Care Center, 12-bed Peace Hospice of Montana, Benefis Quick Care, and Benefis Physician Associates. As of March 2011, it was Montana's largest hospital.
Health care sharing ministries (HCSM) are organizations in the United States in which health care costs are shared among members with common ethical or religious beliefs in a risk-pooling framework in some ways analogous to, but distinct from, health insurance.
José R. Oliva is an American Republican politician from Florida. He served in the Florida House of Representatives, representing the Hialeah and Miami Lakes area in northern Miami-Dade County from 2011 to 2020. He was speaker of the House during his last term in office from 2018 to 2020.
Raymond Wesley Rodrigues is the 12th chancellor of the State University System of Florida since 2023. Previously, he served four terms in the Florida House of Representatives, representing southern and coastal Lee County from 2012 to 2020 and one term in the Florida Senate from 2020 to 2022. His campaign website describes him as conservative.
The Affordable Care Act (ACA) is divided into 10 titles and contains provisions that became effective immediately, 90 days after enactment, and six months after enactment, as well as provisions phased in through to 2020. Below are some of the key provisions of the ACA. For simplicity, the amendments in the Health Care and Education Reconciliation Act of 2010 are integrated into this timeline.
Patient navigators educate and assist United States citizens in enrolling into health benefit plans stipulated in the Patient Protection and Affordable Care Act (ACA). Patient navigators are also called "insurance navigators" or "in-person assisters" who have defined roles under the ACA. Although their roles might overlap, patient navigators are not community health workers or health advocates. "Navigators" work in states with Federally-Facilitated Exchanges (FFEs) or State Partnership Exchanges.
The American Health Care Reform Act of 2013 is a bill introduced to the 113th United States Congress.
Health care analytics is the health care analysis activities that can be undertaken as a result of data collected from four areas within healthcare; claims and cost data, pharmaceutical and research and development (R&D) data, clinical data, and patient behavior and sentiment data (patient behaviors and preferences,. Health care analytics is a growing industry in the United States, expected to grow to more than $31 billion by 2022. The industry focuses on the areas of clinical analysis, financial analysis, supply chain analysis, as well as marketing, fraud and HR analysis.
Executive Order 13765 is the first executive order signed by former U.S. President Donald Trump on January 20, 2017, which set out interim procedures in anticipation of repeal of the Affordable Care Act (Obamacare).
In 2018, the Department of Health and Human Services issued a report, Reforming America's Health System through Choice and Competition. In this report, the federal government encouraged state action to repeal CON laws stating that these laws restricted patient choice and are a significant cause of escalating health care costs. As of May 2019, twelve states (California, Colorado, Idaho, Kansas, New Hampshire, New Mexico, North Dakota, Pennsylvania, South Dakota, Texas, Utah and Wyoming) do not have a CON requirement and four states (Arizona, Minnesota, Indiana and Wisconsin) have a limited CON program for certain health care facilities and services.With the approval of HB 21, Florida will become the fifth state with a limited CON program, requiring review for only certain facilities such as nursing homes and hospice centers.