James.qxp Jan Feb 2019 web - Page 12

he General Assembly is set to convene
its 2019 session on Monday, January
14th. The governor is newly elected.
The lieutenant governor will also be
new, and over one third of the members
of the legislature have never served in
the General Assembly prior to that date. There will
doubtlessly be some new agency heads that will present
a new budget with perhaps different priorities and plans
than any budget that the legislature has considered
before. While there may be many fresh faces, many of the
issues facing the members of the General Assembly will
not be novel at all. For example, in the realms of healthcare, election reform, and judicial policy, the election may
have created different players but the legislative game
remains the same.
Once again, the Rural Development Council (“RDC”)
sent shockwaves through the healthcare community with
its recommendations on Certificate of Need (“CON”) and
taxpayer transparency. Not unlike last year, the RDC
made bold and self-described “revolutionary” recommendations regarding Georgia’s decades old CON program,
which requires hospitals and physicians to ask the state
for permission before opening or expanding most healthcare facilities and the lines of clinical service.
This year, the RDC recommended effectively deregulating the metro-Atlanta marketplace, and loosening the
restrictions imposed on healthcare development in rural
areas. Specifically, new and existing healthcare facilities
that seek to open or expand in the metropolitan Atlanta
area would not require a CON to do so. Those seeking to
open new facilities in rural areas would trigger CON
review only if they sought to open within 20 miles of an
existing provider. As a result, Cancer Treatment Centers
of America would likely achieve their goal of expansion
and Legacy Sports will achieve their goal of opening.
Other providers, including those represented by the
author, would be able to deliver new and innovative services with better technology— without seeking the state’s
approval and becoming subject to challenge from other
providers seeking to maintain their market share. Expect
many in the hospital community to fight these recommendations, but the Legislative drumbeat for some type
of reform continues to grow in volume and consistency.
The RDC did not just look at CON deregulation. It also
recommended doubling the rural hospital tax credit and
increasing transparency for tax-exempt hospitals and
hospital authorities. Courts have begun to address some
of those issues, but it appears that the RDC saw additional value in having taxpayers perceive for themselves the
trade-offs between a hospital’s tax-exempt status and the
community benefit provided to Georgians.
Also watch for Medicaid modernization ideas emerging from the Governor’s office. Medicaid can be a tricky
topic that influences debate on just about every healthcare topic. Managing Medicaid previously was within the
purview of the executive branch, and the General
Assembly provided the appropriations necessary to fund
the program. In 2014, however, the General Assembly
passed into law HB 9909, which requires legislative
approval to increase the income-based eligibility requirements for Medicaid enrollment. Governor Kemp may
attempt other methods to modernize or modify Medicaid
without legislative approval, but the federal government’s
agreement will still be necessary. And with that, CON
appears again. In December, the Trump Administration
stated that it opposes CON generally as anti-competitive,
and that it would take a state’s CON regime into account
before deciding whether to grant or approve certain proposed Medicaid reforms. continued on page 14


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