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Florida House approves certificate of need repeal; sets up Senate showdown

House lawmakers want to remove the regulations for expanding healthcare facilities. The Senate has historically opposed that.
Florida House Speaker José Oliva, R- Miami Lakes. [SCOTT KEELER   |   Times]
Florida House Speaker José Oliva, R- Miami Lakes. [SCOTT KEELER | Times]
Published Mar. 21, 2019

TALLAHASSEE — House lawmakers voted largely on party lines Thursday to fully repeal certificate of need requirements, setting up a showdown with the more reluctant Senate over the state’s long-standing approval system for expanding or adding healthcare facilities.

HB 21, which passed 77-33, would fully repeal the process hospitals, nursing homes and hospices must currently undergo with the state Agency for Health Care Administration to determine whether healthcare facilities can build or add beds. The House has repeatedly sought to remove the process, though the Senate has historically remained opposed to scaling back existing requirements.

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This year, the issue tops House Speaker José Oliva’s legislative agenda, and the Miami Lakes Republican has repeatedly cited it and other deregulatory measures as necessary to push free-market policies into what he has called a ballooning healthcare market.

But SB 1712, the bill’s Senate companion, stalled out in the Senate Monday when sponsor and Sen. Gayle Harrell, R-Stuart, temporary postponed a vote on her own legislation. She later acknowledged to reporters that she worried she did not have enough votes among fellow Republicans to pass it.

Florida is one of nearly 40 states in the country that has a certificate-of-need, or CON, process, though House lawmakers have successfully approved repealing it multiple times in the last five years. Each time, the push to do so has died with the state Senate.

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Supporters of the repeal have said the certificate of need system unfairly chokes potential competition to already-open facilities and allows them to inflate their costs, though opponents have said higher volumes of cases are needed to keep providers trained to deliver complex treatment and let them offset their costs with paying patients.

Sponsor Rep. Heather Fitzenhagen, R-Fort Myers, cast her bill on the House floor as needed to lower ballooning costs, and framed it as “one of several very bold steps we are taking to provide better quality healthcare at a more competitive price.”

But several Democrats, including Rep. Evan Jenne of Dania Beach, questioned if those outcomes would occur. Jenne, in particular, argued that the measure would enable for-profit providers “with the deepest pockets” to fund competing facilities and cherry-pick patients away from existing hospitals to lower quality of care.

“Volume saves lives,” he said repeatedly. “This bill decreases volume.”

But Fitzenhagen, in closing on her bill, aggressively countered what she called “spurious correlations.”

“Quality and competition are distinct — we have methods in place through licensure and inspection and rules to keep Floridians safe,” she said. Removing CON “will be able to improve healthcare and drive costs down in Florida.”

The bill has also been opposed by a number of healthcare industry groups representing some hospitals and other facilities.

CON regulations “ensure access to acute care services for all Floridians even when they live in low-income areas with high numbers of uninsured people,” said Florida Hospital Association President Bruce Rueben in a statement. “The Florida Hospital Association believes that access to hospital services is necessary and vital for all Floridians. “

Nursing home and hospice groups in particular have been concerned about their inclusion in the proposed repeal — past proposals have omitted them. The Senate bill is limited only to removing CON for hospitals.

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The passage of the repeal in the House kicks the debate over to the other chamber, where it is still unclear when or if the measure will again be heard this session.

One of the holdouts on the measure, Sen. Aaron Bean, R-Fernandina Beach, said when the bill was postponed that he considered certificate of need requirements as a way for the state to allocate the taxpayer dollars that highly subsidize hospital construction. But he also told reporters Wednesday that he is meeting again with Harrell and others to see if he might reconsider his stance on the bill.

The stalemate over the certificate of need repeal unfolds as House and Senate Republicans have begun pitching their budgets for the next fiscal year. They diverge on how to fund the state’s healthcare agencies by more than $543 million, and leaders in each chamber are expected to negotiate in the next several weeks to craft a balanced budget.

Senate President Bill Galvano, R-Bradenton, has nodded to infrastructure changes as a top priority and signaled that he has reservations about the House’s broad deregulatory moves.

But, when asked by a reporter if the bill had been deliberately stalled as leverage in potential future negotiations, Galvano denied the delay was strategic or might be linked to negotiations down the road with a Senate-priority infrastructure bill.

“We genuinely have senators on the Health Policy Committee who are questioning the CON deregulation, that have concerns,” he said. “We’re being deliberative.”

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