The state’s Certificate of Need (CON) process requires hospitals and other health care providers to obtain state approval before opening, expanding or adding certain medical services. Supporters of CON say the system helps prevent unnecessary duplication and protects access in vulnerable areas, while critics argue it can slow investment and entrench existing disparities.
The Legislature passed a limited CON reform bill last year, but Gov. Tate Reeves vetoed it over a provision dealing with a specific hospital.
Senate Public Health Chair Hob Bryan, D-Amory, says wrapping up that unfinished business quickly is a priority for him and his House counterpart, Rep. Sam Creekmore IV, R-New Albany.
“I think we’re gonna pass a bill that’s essentially the same bill again, removing the governor’s objections, and I hope we'll get that done before the end of the month,” Bryan said.
Like last year's version of the bill, this latest iteration raises the dollar thresholds that trigger CON review, tightens the University of Mississippi Medical Center’s academic exemption and orders additional studies on potential future exemptions.
As lawmakers move to approve those modest reforms, Mississippi’s State Board of Health is urging them to consider major structural changes to the CON system. During their quarterly meeting Wednesday, the Board adopted three core policy recommendations aimed at stabilizing rural hospitals’ finances and increasing the availability of high-need services.
The recommendations include exempting rural hospitals from CON requirements when they want to add services, as long as they already provide 24/7 acute care.
Bryan thinks that kind of change could help reverse some of the financial damage done to rural providers by shifts in health care delivery. During a Public Health Committee meeting Wednesday, he pointed to shorter hospital stays and the migration of higher-margin procedures to outpatient settings as key pressures on rural hospitals, which are still required to maintain emergency rooms, inpatient beds and on-call staff around the clock.
“As those sources of revenue and just the volume is moved out, life is getting more and more difficult for hospitals, particularly small ones,” Bryan said.
The Board’s recommendations are informed in part by a state-commissioned analysis from Health Management Associates, which found CON approvals for new services tend to cluster in healthier, faster-growing counties, rather than areas with the greatest health care needs.
After Wednesday's Board meeting, State Health Officer Dr. Daniel Edney said if the current CON framework is not directing investment where it's most needed, providers in those areas should have more flexibility to respond to local demand.
“If they have a CON now and they’re providing 24-7 care to their communities, the state needs to get out of the way and let them invest in themselves,” Edney said.
Edney emphasized that the Board’s proposal is not a repeal of CON and would not allow new competitors to enter new markets unchecked.
“It still allows CON to prevent cherry-picking,” Edney said. “It just allows folks who are already there doing the work, taking care of their communities to do more if they want to.”
The Board is also recommending high-need service areas like perinatal care and substance abuse treatment be exempted from CON requirements, arguing state review in these cases mostly adds cost and delay.
The debate comes as financial pressures on rural hospitals continue to mount. A report released in December by the Center for Healthcare Reform and Quality found that more than half of Mississippi’s rural hospitals are at risk of closure due to financial challenges.
