State regulators predict hospice growth if state relaxes health care rules

If Florida eliminates its “certificate of need” program (CON) for health care facilities the number of hospices built in the state would increase.

That’s what Jeff Gregg, who oversees the state’s CON program in the Agency for Health Care Administration, told the House Health and Human Services Quality Subcommittee on Tuesday as he gave members a primer on the regulatory program that limits the number of hospitals, nursing homes and hospices that can be built in the state without prior approval from Florida health care planners.

Florida law requires a CON for new hospitals, nursing homes, hospices and intermediate care facilities for the developmentally disabled, commonly called ICFDDs.  Even though nursing homes are subject to CONs the Legislature put a moratorium on any new nursing home beds in 2001.

Gregg told the committee that there are fewer than five employees in the CON program and that from the agency’s perspective the program “is kind of obscure.”

That is not the case for the industries affected by it, though, said Gregg who noted that hospitals, nursing homes and hospice programs “tend to cling quite tightly to it.”

Gregg said eliminating CONs could increase the number of hospitals or nursing homes but that capital constraints and staffing requirements could be obstacles even if CON was eliminated.

But Gregg warned that hospice programs do not require as much capital investment as the larger facilities and that the care provided isn’t as intense.

Without those market barriers hospices could abound, similar to what occurred with home health agencies when the state eliminated CON requirements for them, Gregg said. 

Subcommittee chairman Rep. John Wood, R-Haines City, said he wanted committee members to understand the CON program and how it will play in Florida’s evolving managed care market place. He said the presentation from AHCA does not mean that there will be a “specific legislative agenda” that will be brought forward during the upcoming legislative session.

But at least one member of the committee expressed sentiment that CONs may not be required for nursing homes and hospitals 

“It just seems to me like we can make the free market work,” said Rep. Matt Hudson, R-Naples, who said he can see the need for keeping CON requirements for hospice but not for institutional facilities. “Who is going to make that capital investment with an uncertain market place?”

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