ATLANTA — As meetings to assess certificate of needs for health care facilities in Georgia come to an end, committees are preparing to make recommendations to lawmakers ahead of the 2024 legislative session.

Hospitals and health care facilities in rural areas appear to be the central talking point among officials discussing the impact of CON laws, which were originally signed into federal law in the mid-1970s as a way to assess the availability and duplication of health care services within a certain radius.

Congress repealed it nearly a decade later leaving it to states to decide, and approximately 15 states have since rolled back their CON laws.

This Georgia House and Senate committees planned to host a handful of meetings around the state to hear from health care officials and residents.

The committees plan to provide recommendations on whether to repeal or reform CON laws for hospitals and/or all types of continuum of care facilities.

Opponents of CON say the restriction has contributed to the rising cost of health care and decreased health care access, while proponents of CON say it helps provide balance and a repeal could negatively affect rural hospitals as they would have to compete with newer hospitals.

“I wanted to open a birth center that not only provided mental health, physical health, nutrition, breastfeeding, counseling, I wanted to find a center that could revolutionize maternity care in the world,” said Katie Chubb, founder of Augusta Birth Center at an Aug. 1 committee meeting. “We filed for a certificate of need back in 2021. I’ve done the whole process — 826 pages I wrote and filed and fought. Sadly, we were denied. We’re unable to open and serve these mothers.”

Chubb, who sued the state over the denial, said she was denied because the local hospital would not enter into a transfer agreement as required under CON.

Chris Denson, director of policy and research for Georgia Public Policy Foundation, compared Georgia to North Carolina, which he said has similar geographical and rural populations.

North Carolina has a CON requirement for hospital and ambulatory surgery centers and has had the most rural hospital closures, he said. He also referenced Florida, which repealed CON laws in 2019 for everything except specialty hospitals and longterm care facilities.

“During that time, they have received or they have announced 64 ambulatory surgery centers opening which [are] where elective outpatient surgeries are held,” Benson said to the House Study Committee on Certificate of Need Modernization on Aug. 1. “And in that area, 63 of those were located in urban counties; only one of those actually operated and located in a rural county.”

In summarizing academic research analyzed by the Georgia Public Policy Foundation, Denson noted:

• 60% of tests examined were associated with worst health care spending outcome;

• 82% of studies associated CON with diminished availability of access and health care services;

• 55% of tests examined associated CON with diminished quality of services;

• 80% of tests examined associated CON laws with worse outcomes for underserved populations;

Denson referenced other states, like North Carolina, that have implemented population thresholds for counties to remove CON requirements for certain facilities.

Since the 1990s, Jimmy Lewis, CEO of Hometown Health, said 16 rural hospitals have closed in Georgia. A Becker’s Hospital Review report indicated that 12 of the 300 rural hospitals in the U.S. at risk for closure are located in Georgia.

“I can tell you that when you carry a hospital through to a closure, you carry the communities through mental anguish beyond anything that you can imagine,” Lewis said. “The thing that’s interesting here is the population that’s impacted by this is rural, all rural, and when these close, that community goes away.”

Lewis said health care worker shortages, financial stress, inflation, transportation issues and other factors contribute to the strain on rural health care facilities, and removing CON requirements could add to the burden.

He offered the committee suggestions that he said could help diminish rural health care issues including expanding Medicaid; increasing the rural hospital tax credit; subsidizing OBGYNs; and creating rural stipends for rural physicians.

Rep. Sharon Cooper, a member of the House Study Committee on Certificate of Need Modernization, suggested that new hospitals may be needed in rural areas to provide more preferred or quality choices or technologies for residents in rural areas.

“Isn’t it better to try to find a new way to get people in these rural areas that don’t have enough people surrounding them to get them that kind of care, rather than trying to keep supporting a rural hospital that’s old, doesn’t offer some of the latest techniques and the latest services that are more up-to-date and easier on the patients,” she said.

The Senate Study Committee on CON Reform will host its second meeting on Aug. 28 at 9 a.m. at the Hughston Foundation located at 6262 Veterans Parkway in Columbus.