A few changes in the complicated rules that govern hospital and other medical facility expansions in North Carolina moved through the North Carolina General Assembly this week.
Some Republican lawmakers have pushed for years for much deeper reforms or for outright repeal of the state's Certificate of Need process, which requires bureaucrats to analyze whether new equipment or facilities are needed in a given area before they're approved. The idea is to protect hospitals from smaller operations that siphon off insured patients and the most profitable procedures.
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Lawmakers jettisoned most of those rollbacks this year in favor of a bill that won widespread, bipartisan support in the Senate, then easily passed the N.C. House Tuesday after waiting months for a House committee hearing. Senate Bill 462 would allow medical practices to add more equipment without having to undergo the Certificate of Need process. It would also put a time limit on approved projects to keep people from hoarding valuable state approvals just to limit competition.
Rep. Donny Lambeth, R-Forsyth, a retired hospital executive and a key Republican leader in the North Carolina House, called the bill Tuesday "a reasonably good compromise the House should be able to support." The North Carolina Healthcare Association, which represents hospitals at the General Assembly and has resisted CON reforms for years, said it doesn't oppose the bill.
The bill would do the following:
- Increase the threshold above which certificates of need would be required for diagnostic equipment from $500,000 to $1.5 million
- Increase the threshold for major medical equipment from $750,000 to $2 million
- Increase the threshold for capital expenditures for new institutional health services from $2 million to $4 million
- Index all these thresholds to inflation to be adjusted at the end of September each year, starting next year
- Add new caps to the length of time a certificate can be held before construction starts. Projects costing more than $50 million would have to begin within four years, and projects costing $50 million or less would have to start within two years.
Sen. Joyce Krawiec, R-Forsyth, a bill sponsor and a leading voice for CON reform for years, said the cost thresholds in the bill haven't increased for 30 years.
"This is only adjusting for medical inflation," she said.
This bill passed the state Senate in May, then waited for action in the House until Tuesday, when it cleared committee. It was added, later in the day, to the House floor calendar, where it passed 100-3. The bill now heads to Gov. Roy Cooper for his signature.