The Kentucky legislature created a special task force last week to study the issue of certificate of need during the interim legislative period, the time in between legislative sessions when legislators specific policy issues that might be addressed in the upcoming legislative session.
A certificate of need is required under Kentucky law for healthcare providers to open up a new facility, acquire major medical equipment, make substantial changes to a facility or project, or “Alter a geographical area or alter a specific location which has been designated on a certificate of need or license.”
According to Kentucky’s state health plan, certificates are issued by the Kentucky Cabinet for Health and Family Services, and there are currently 21 medical services that require certificates of need.
In the Northern Kentucky counties of Boone, Campbell and Kenton there are 109 certificates of need and St. Elizabeth holds nine. As far as hospitals, they hold four of these NKY counities’ seven total certificates with St. Elizabeth Florence, St. Elizabeth Ft. Thomas, St. Elizabeth Edgewood, and St. Elizabeth Covington.
The other three hospitals are: Encompass Health Rehabilitation Hospital of Northern Kentucky (formerlyHealthsouth Northern KY Rehabilitation Hosp; formerly American Hosp for Rehab); Gateway Rehabilitation Hospital at Florence (formerly River Valley Rehabilitation Hospital); and SUN Behavioral Health (aka Northern Kentucky Behavioral Health Hospital; formerly NorthKey Community Care Intensive Services; formerly Children Psychiatric Hosp) TB Dedicated Beds.
However, some in NKY argue that St. Elizabeth has a healthcare monopoly — though the medical group argues they legally aren’t a “monopoly”; instead, they hold dominant healthcare status.
The new task force was created from Senate Concurrent Resolution 165, sponsored by Sen. Gex Williams (R-Verona), and House Concurrent Resolution 85, sponsored by Rep. Marianne Proctor (R-Union).
The task force will be tasked with doing three things.
- Review Kentucky’s certificate of need program, including the state health plan and related statutes;
- Review the need to maintain or modify certificate of need for each covered health service; and
- Submit any findings and recommendations regarding certificate of need to the Legislative Research Commission for referral to the appropriate committee of jurisdiction.
“My hope for the committee is that we can take a deep dive into this complex issue to see what certificate of need reforms could be made to improve health care choices in Northern Kentucky,” said Sen. John Schickel (R-Union), a committee member.
Schickel, the longest-serving legislator from NKY, noted that during his time in the legislature, the topic has come up each year and continues to be a big concern.
“I’ve really seen it change over the last 15 years,” Schickel said, noting that it’s a complex issue and there might not need to be changes to certificate of need, but it’s important to explore and understand the point of view from all the stakeholders involved.
The Boone County legislator pointed out that Northern Kentucky is the only metropolitan area in the state where folks don’t have choices.
“I’m not an expert on the subject,” Schickel said. “It’s very complex. It may not need to be reformed. But from my point of view, I think it does.”
However, St. Elizabeth CEO Garren Colvin said that NKYians do have options.
“I think from my perspective, competition is in Northern Kentucky today,” Colvin said. “We don’t see it changing significantly.”
In the 2023 legislative session that ran from January until the end of March, Williams and Proctor filed legislation to challenge certificate of need laws in Kentucky and how they apply to NKY. None of the legislation moved in the legislature, though House and Senate leadership signaled they would be willing to discuss it in the interim.
Proctor filed House Bill 312, which would have allowed any healthcare provider to operate in the three northernmost counties — Boone, Campbell, and Kenton — without first requiring a certificate of need.
Williams filed two pieces of legislation — Senate Bill 146, which would have allowed local governments to provide an exemption to the certificate of need to a healthcare facility. The second bill Williams filed — Senate Bill 26 — would repeal the Kentucky statute certificate of need in the state.
The topic has also come up at local city meetings, and Colvin has spoken at the meetings where he characterized St. Elizabeth as a “safety net hospital,” which is not an official, legal designation but refers, instead, to St. Elizabeth’s policy of accepting all patients regardless of their ability to pay.
Colvin said if asked, the hospital would present to the committee. He also thinks it’s a good learning opportunity for members of the House and Senate to learn about CON.
“I’m pretty sure that they will discuss the services that are currently under the purview of CON and see if that needs to be modified,” Colvin said.
The Task Force will meet for the first time at 10:30 a.m. on June 19.
Certificate of Need Task Force membership includes:
- Sen. Donald Douglas (R-Nicholasville) – co-chair
- Rep. Russell Webber (R-Shepherdsville) – co-chair
- Sen. Karen Berg (D-Louisville)
- Senate President Pro Tempore David P. Givens (R-Greensburg)
- Sen. Steve Meredith (R-Leitchfield)
- Sen. John Schickel (R-Union)
- Rep. Lindsey Burke (D-Lexington)
- Rep. Daniel Elliott (R-Danville)
- Rep. Marianne Proctor (R-Union)
- Rep. Susan Witten (R-Louisville)
Correction: This article previously state that there is only one certificate of need in Northern Kentucky. It has been updated to reflect that there are 109 total certificates and St. Elizabeth has 19.