State Rep. Marianne Proctor filed three separate bills on Tuesday that would reform Kentucky’s certificate of need law without carving out a specific exemption for the Northern Kentucky region, as she proposed in 2023.
The centerpiece of the three bills is a proposal that would exempt more types of facilities and services (rather than a geographic area) from Kentucky’s certificate of need law. Those exemptions would include dialysis centers, freestanding birth centers (legal but not operating in Kentucky), psychiatric hospitals, physical rehab centers, hospice, home health, and alcohol and drug abuse rehabilitation services. The legislation sponsored by Proctor is House Bill 203.
“Those specific industries would not need to go through the certificate of need process,” Proctor told reporters Tuesday.
Certificate of need exemptions in Kentucky are now largely limited to assisted living centers, veteran nursing homes, rural health clinics, group homes, freestanding residential substance use disorder treatment facilities, and outpatient behavioral health treatment centers.
The new bill differs substantially from legislation sponsored by Proctor last year. That bill unsuccessfully proposed exempting NKY’s core counties of Boone, Campbell, and Kenton from the certificate of need process. The measure was HB 312.
So far, Proctor has not filed similar legislation in the 2024 state legislative session that began Jan. 2.
A second certificate of need bill sponsored by Proctor Tuesday would allow health care facilities to spend up to $10 million on capital improvements without requiring a certificate of need. The threshold to trigger required certificate of need for adding major medical equipment to a facility would be $5 million (the current minimum is $3.98 million, Proctor said Tuesday). That bill is HB 202.
Proctor said the legislation would help the health care industry keep up with the cost of inflation.
“That number can’t go backward,” Proctor said of the thresholds in the bill.
The third certificate of need bill filed so far this session by Proctor is HB 204. That proposal, she said, would prevent hospitals or “dominant” certificate of need holders from holding up certificate of need approval of a facility or service with a judicial appeal or request for reconsideration from the state. It would also guarantee public hearings for certificate of need applicants.
A certificate would be issued 40 days after the state Cabinet for Health and Family Services makes a decision to grant the certificate of need, according to the bill.
“It doesn’t change the process,” Proctor said of HB 204. “It doesn’t take away any of the rights of a dominant provider. It just prevents them from suing along the way. It levels the playing field.”
The NKY region has been a hotbed of debate about the certificate of need process over the past two years. Most debate has centered on St. Elizabeth Healthcare, the region’s largest healthcare provider. The company holds four of the region’s seven required certificates of need for hospitals and approximately eight percent of NKY’s total certificates of need for all facilities and services.
Proctor told reporters that her bills address what she called “the imminent risk that we face right now” in health care services and access in Kentucky.
“Since 2006 in Kentucky, we’ve had four rural hospitals that have closed, and we have 12 that are in danger. And that is with certificate of need. We are far, far behind,” she told reporters. “If you have one provider, it’s Economics 101; It doesn’t make it more affordable, it doesn’t make it more accessible.”
A 2023 state legislative task force on certificate of need opted not to recommend specific changes to the state law when it issued its final report in December. Proctor was a member of that task force. Although she voted to accept the task force report, Proctor told LINK nky after the final task force meeting that she would file certificate of need legislation in 2024.
A resolution to reestablish the task force for 2024 is pending in the Kentucky Senate.
In response to the bill filings Tuesday, St. Elizabeth Healthcare president and CEO Garren Colvin released the following statement:
“After more than six months of study, the legislature’s Certificate of Need task force recommended further analysis of the issue in 2024, noting that CON has far reaching impacts on both business and health in the Commonwealth. St. Elizabeth supports this recommendation and feels that any legislation to reform CON before the task force has completed its work would be premature.”