MEMORANDUMTO: Georgia Governors policy advisorFROM: Pranay NeemaDATE: March 6, 2015SUBJECT: Georgias (GA) Certificate of Need (CON) policy revision need and recommendation in light of Affordable Care Act (ACA).

The ACA implications for the healthcare market and the goals of CON process in Georgia.The ACA has many key provisions that may affect the provider market and CON program:1. To provide universal health coverage to all citizens. 2. To improve the quality of care and making healthcare more affordable while decreasing the rising healthcare cost and spending.3. To improve the access to primary and preventative care while continuing investments in the community and public health policies and their enforcement. 4. To reform provider payment method and to focus more on quality and efficiency. This may help to restore some of the market constraints on expansion seen during the 1990s.[endnoteRef:1] [1: Health Care Certificate-of-Need (CON) Laws: Policy or Politics? NIHCR Research Brief No. 4 May 2011Tracy Yee,Lucy B. Stark,Amelia M. Bond,Emily Carrier. (http://www.nihcr.org/CON_Laws).Testimony from the Primary Care Development Corporation to the Joint Senate Finance, Assembly Ways and Means. Public Hearing on the 2014-15 Executive Budget Proposal: Health and Medicaid. Author: Daniel Lowenstein, Primary Care in the News, February3, 2014 http://www.pcdc.org/news/pcdc-in-the-news/pcdc-budget-testimony-2104-15.html#sthash.0sEMOBr4.dpuf.]

Decreasing the uninsured by making health coverage affordable and to provide improved quality of care to more people will increase the demand for healthcare services. This may result in an increase in demand for greater provider capacity. Further, the above provisions will have mixed effects with varying impacts across the United States (U.S.). As CON process also have the similar goals and purposes, CON will be required to even greater ability to shape GA healthcare market. The current CON policy in Georgia aims to improve access to safety net hospitals and access to care especially primary care in addition to maintaining quality. Furthermore, it aims to improve community benefits, to keep healthcare as a non-competitive market and to reduce competition to check the increased cost.

Recommendations:The CON policy was written with significant goals in mind. However, there is a need for revision of CON law and its implementation process to ensure execution of objectives as follows:1. There should be more focus on post-CON approval outcome, evaluating and enforcing standards is required by State Health Agency. Meeting the post-approval requirements should be a mandate for all CON projects. Instead, the providers are becoming more serious and savvy on getting CONs; there are difficulties reported by the state agency in evaluating applications mainly because of inadequate staffing and funding. In order to accurately assess the commitments made by the provider regarding improved access along with affordable and quality of care for Georgians, more rigorous and continuous CON evaluation method is required. However, with fewer means to enforce those commitments, the intended influence of CON on access and quality of care may remain limited.

2. The ACA helps to get access to care at an affordable cost especially to uninsured people results in an increase in demand for healthcare services. The current CON process takes very long time to complete as applicants often face multiple delays at several stages of the review. In order to meet the increasing demand for healthcare services, provider capacity and community-based services with CON process, it is highly recommended to make the CON process more efficient. Also, the appeals and review process should be done more timely with built-in time limits for filing and in decisions making.

3. Another recommendation is the elimination of CON for primary care facilities to meet the need of primary care capacity. CON has primarily been used to check the oversupply of medical services. However, as there is high unmet need of primary care, CON process becomes a barrier to increasing the supply in order to meet the increasing primary care demands.

4. Home Health Agencies (HHA) in CON program should be either remove or move to non-substantial review. The HHA is determined as health agency by the legislature that require a certificate of need. However, there is an increasing focus towards outpatient-centric care under the ACA and current health care market trend. Further, as the nature of institution care and home health agency care is different, the approval process need to be different. The CON process ought to recognize the way HHA and its lessened cost by reducing the obstruction to entry to a threshold below the current formal review process. Therefore, the home health agencys inclusion in the health facility and the CON program is obsolete and must be re-evaluated and redesigned.

5. In rural and under-served communities, retention of physician practitioners is critical. Facilities must hire physicians in order to retain them. However, the current CON process delays the conversion of private practices to primary care settings. This delay is contrary to the goal of improving access to primary care. Thus, indicates the need to reform CON process as meeting needs of the patient should be the motivating factor and not the process fulfillment.

6. Lastly, reducing unnecessary CON regulations will benefit other goals of health care reform, such as the creation of integrated health systems, medical homes and accountable care organizations.References: