Md. health facilities’ certificate of need process under review

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Maryland may change how it regulates medical facilities in the state after a state task force heard concerns from stakeholders about the process.

A task force formed by the Maryland Health Care Commission examined the certificate of need process at the behest of the legislature’s regulating committees and will spend the second half of 2018 coming up with recommendations to change the process.

“The common themes that emerged were the most of the regulated facilities, the folks that had (certificates of need), saw the need for some regulation,” said Randolph S. Sergent, a Maryland health care commissioner who co-chaired the certificate of need task force. “There has not really been a push to eliminate (certificate of need) as an entire concept.”

For its first phase, the task force heard from all of the stakeholders in the certificate of need process, especially the hospitals, ambulatory surgical facilities, hospice facilities and nursing homes that go through the process. Now, with the commission approving its interim report, the task force will come up with recommendations by Dec. 1 for the legislature to consider.

The certificate of need process regulates proposed health care facilities and how they fit with the state’s health plan.

The process can be long and onerous for many providers, providing a barrier to entry in the state.

Barry F. Rosen, an attorney who handles certificate of need applications, served on the task force. He tells clients to expect an 18-month process that will cost hundreds of thousands of dollars, something that convinces many potential providers to not even try.

But once companies get the certificate of need, they love the process because it reduces competition, he said.

“When they start out and they want a certificate of need, they hate all of your regulations,” Rosen told the health care commission. “If they are lucky enough to get a certificate of need, they love all of your regulations because it keeps other people from getting a certificate of need and competing with them.”

Rosen encouraged the commission to adopt recommendations that could be changed not just at the legislative level, but also the commission level.

Big changes will be fought by people who have certificates of need, he said.

“It may be inconsequential for a report to say eliminate something, because it’s not going to be eliminated because it’s not up to you,” he said.

But other members of the commission encouraged the task force to think big when coming up with recommendations.

“I want to encourage you all to think big. Think outside the box,” said Cassandra Tomarchio, a commissioner. “Go crazy with it and do something that’s really going to make a difference because we don’t get these opportunities very often.”