House Speaker Jose Oliva/photo by Mark Foley

Eliminating the certificate of need program for hospitals may have been the easy part, but how to license them in the future may be more complex.

Tallahassee health-care regulators on Wednesday started the layered process of reshaping the state's certificate of need program, moving ahead to focus it on nursing homes, hospices, and institutions for individuals with developmental disabilities.

But the proposed changes to the CON rules are only the beginning of a two-step process for Florida hospitals, as the Agency for Health Care Administration simultaneously moves to change the licensure requirements for hospitals.

The changes are necessary after the Legislature eliminated certificate of need program requirements for general acute care hospitals and tertiary services. The new law, which went into effect last Monday, keeps CON requirements for specialty hospitals in place until July 1, 2021.

Agency officials considered a pair of proposed changes to the CON regulations at a public meeting last Wednesday.

Before the new law, regulators reviewed applications in four cycles: two for hospitals and two for “other beds and programs.”

The proposed rules would maintain the four review cycles, but split them into two different categories. One category would deal with applications for hospital facilities and hospice.

The other category would be dedicated to nursing homes and intermediate-care facilities for individuals with disabilities.

The regulators moved quickly Wednesday to quash any questions related to any of the future licensure requirements that also are under consideration, such as changes to the rules for tertiary programs.

“I would like to just ask that we limit our questions to the rules that we are addressing today, as opposed to the questions related to HB 21 or other impacts that we will be addressing,” said Laura MacLafferty, AHCA bureau chief of Health Facility Regulation. “We will have rules that address those services in the very near future on the licensure side, as opposed to the CON rules we are addressing today.”

House Speaker Jose Oliva, R-Miami Lakes, made eliminating the certificate of need programs a top priority during the legislative session that ended in May. Gov. Ron DeSantis signed the CON measure into law last month.

Florida has had a CON program since the 1970s. The program limits the ability to create health-care services and build new facilities. Advocates for CON have argued that overbuilt environments can lead to overutilization and can increase health-care costs. Moreover, proponents maintain that certificates of need help create safer environments in a variety of ways. For example, providers must perform a minimum number of procedures to maintain their certificates.

Opponents of the process argue that it limits the free market and, because CONs stifle competition, leads to increased costs. Critics have long argued that the requirements to maintain CONs can be shifted from certificates of need to licensure requirements.

Though the changes mostly impact hospitals, most health-care providers are watching them closely. Wednesday's meeting at the agency's headquarters was standing room only. A telephone line was available for those who couldn't travel to Tallahassee to attend the public meeting.

“This is a major change to our health-care laws, and it's more than nuance here because there also is going to be change to the licensure law,” said Florida Health Care Association lobbyist Bob Asztalos said of the larger-than-usual crowd.  “I think the question everyone has here is, how much of the CON requirements for hospitals will actually roll over into licensure. We'll see how much leeway the agency is going to give hospitals to build or whether or not they are going to have a lot of requirements in licensure.”

Christine Sexton reports for the News Service of Florida.