ATLANTA — Legislation to reform or scrap Georgia’s certificate of needs laws for health care facilities stalled in the 2023 legislative session but now committees are meeting to determine the best way forward.

The Senate, in a 42-13 vote Feb. 27, approved Senate Bill 99, which would exempt acute care hospitals looking to locate in rural counties (or counties with less than 50,000 residents) from adhering to CON requirements. The bill, however, stalled in the House.

State Sen. Greg Dolezal, the bill’s sponsor, said the proposal was the result of an undisclosed health care developer’s interest in building another hospital in Butts County where the population is less than 26,000. The county currently has Wellstar Sylvan Grove Medical Center in Jackson.

Sen. Ben Watson sponsored another bill, SB 162, that would have repealed CON in its entirety. The bill, however, did not make it out of its Senate committee.

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

Lawmakers passed a resolution this session to create the Certificate of Need Reform Study Committee to determine ways to have better health outcomes at lower costs and to determine policies for financially struggling rural hospitals to survive and grow.

The committee, appointed by Lt. Gov. Burt Jones, first met June 13.

Jocelyn Hill, a senior policy analyst in the Georgia Senate Research Office, presented research to the committee from various reports and studies on CON laws and their affect on expenditures, regulatory costs, health care outcome and access to care.

“The results provided mixed results with average findings that certificate of need increases health expenditures and overall elderly mortality while reducing heart surgery mortality,” Hill said. “They had mixed results among their different outcomes in different categories that they were looking at. Their conclusion was that based on their reviews, and what they looked at that, CON laws aren’t necessarily meeting the objectives that they were put in place for.”

CON requirements were 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 Congress repealed it nearly a decade later leaving it to states to decide.

Twelve states have done away with CON laws, most recently South Carolina this year establishing a three-year sunset for its CON program. Counties without hospitals, however, can move forward with building hospitals and clinics.

Though specific procedures and costs varied among different states, Hill said CON regulations led to lower quality care for some measures of quality and have little to no effect on other measures of quality.

Thomas Stratmann, a senior researcher at the Mercatus Center at Georgia Mason University, said Georgia ranks seventh with highest number of CON laws.

For example, Georgia laws require hospitals to get approval to add a new bed, to open a new hospital, to purchase a MRI machine or CT scanner and to open up an ambulatory surgery center.

He said states with CON laws have less patient access to medical care and lower quality of medical services.

“The data shows fewer hospitals in CON states than states without CON,” Stratton said. “Around 2017, Georgia had 175 hospitals, comparable states to Georgia without CON has 227 hospitals. So a state without CON has more than 30% more hospitals. So this shows us also that CON reduces access to medical care because there are fewer hospitals available.”

Ana Adams of the Georgia Hospital Association, representing more than 140 hospitals across Georgia, told committee members to avoid a complete CON repeal. Keeping some restrictions, she said, could protect quality and prevent proliferation of one service.

“We have issues across the state with access to trauma care. We have issues with maternal mortality. Each of those things is a really large substantial issue that I think all of you want to address and have been trying to address and they’re not necessarily linked to certificate of need,” Hill said. “So what we would ask is that you sort of take a holistic approach to looking at health care, trying to figure out where we can make some changes that will be helpful for hospitals, physician practices, nurses, etc.”

The committee will set future meeting dates for August in Columbus, Savannah in October and the State Capitol in November.