HELENA, Mont.-The 25th anniversary of Montana's certificate-of-need law may be observed with the aid of a toolbox or a wrecking ball, officials say.
Leaders in the state's Department of Public Health and Human Services are meeting with their healthcare business counterparts, lawyers and consultants throughout the month to determine whether Montana's CON law should be slightly modified or taken to the Legislature for radical changes or even repeal.
State officials said Montana's healthcare providers have repeatedly aired concerns about the CON law, prompting a closer look.
Montana's law was the subject of numerous complaints by recent CON applicants interviewed for a state-commissioned study released in late January.
Many said that because of the vague language in the application process and the exhaustive procedures to obtain a CON, often only the best-financed projects can proceed. Denver-based consulting firm Policy Studies conducted the 106-page study, which blamed the CON law for the aging of the state's nursing home bed inventory. There have been no CON applications to build or expand skilled-nursing facilities since 1994.
"There's a consensus that the law needs to be streamlined, but there's been no major agreement on what needs to be done," said Nancy Ellery, administrator of the department's health policy division.
Montana is one of 38 states with a CON law, according to the study.
Montana's law has been on the books since 1975, although it has undergone several changes.
Current law requires state approval for the construction and most expansions of nursing homes, home health agencies, ambulatory surgery centers, rehabilitation hospitals and drug treatment facilities. Circumstances that trigger a CON review are the addition of 10 beds, or a 10% expansion, of existing licensed capacity, capital expenditures of more than $1.5 million or the addition of services with annual operating expenses of more than $150,000.
However, since 1989, the state has exempted from CON review virtually all construction and expansion involving acute-care hospitals and clinics. The exemption responded to lobbying by the hospital industry.
The study suggested that CON applications be eliminated in Montana's urban areas-where it concluded that competition among all providers is relatively healthy-and strengthened in rural areas to protect more-vulnerable providers from competition.
The study recommended adding hospital and clinic review to the CON process in rural areas if reviews are scrapped in major cities.
The MHA, Montana's leading hospital lobby, has yet to take a position on whether the CON law should be revised. Its members have not reached a clear consensus about what needs to change, MHA Vice President Robert Olsen said.