Media Get It Wrong Again
Weekend newspaper coverage of a modest change to Iowa’s Certificate of Need (CON) law contained in House File 2700 (the standings and salaries bill) and some subsequent follow-up media coverage again missed the mark regarding what actually transpired in the Iowa General Assembly.
In 1997, the Iowa General Assembly made a distinction between the relocation of a health care facility and the replacement of a health care facility, rightly maintaining that a facility replacement does not add new service capacity to a community and therefore should not require review by the Health Facilities Council. Since that time, the Department of Public Health (DPH) has historically used the county line as the determining factor to distinguish between a replacement facility and a facility relocation. Several hospitals entered into hospital replacement projects over the past decade without the need for review from the Health Facilities Council. However, during the past year, Wellmark challenged that county-line interpretation in District Court and won, with the decision now being appealed by DPH to the Supreme Court.
The language in HF 2700 merely aligns state law with the same federal Centers for Medicare & Medicaid Services requirements that a Critical Access Hospital must meet to qualify as a hospital replacement project: maintaining 75 percent of the same service area, 75 percent of the same services and 75 percent of the same staff. Additional state review for hospital replacement projects is both costly and time consuming to rural hospitals. And it is unnecessary given the scrutiny that local hospital boards give to such project considerations. The federal standard should be sufficient. Neither Wellmark nor DPH opposed this language.
Despite other subsequent news reports, House File 2700 makes no other changes to Iowa’s CON statutes. All new or relocating health facilities will still require the approval of the Health Facilities Council.
IHA advocacy regarding this policy initiative spanned several weeks. The IHA Board approved a formal position paper outlining this strategy at its February meeting (a position paper that’s been publicly available on the IHA Web site since that time - click here to view it). The issue was considered in the House and discussed with a variety of legislators more than two weeks before the bill was passed by that chamber. And despite Senator Jack Hatch’s (D-Des Moines) media assertion that somehow this bill was handled in a secretive manner and was a “very undemocratic thing,” he sponsored an amendment to specifically strip this language from HF 2700. His amendment was debated by the Senate, illustrating specific legislative deliberation on this topic. His amendment lost on a 26-11 vote; his comments smack a little of sour grapes.
This issue was not a secret. This issue is sound public policy. This issue actually will save money for rural hospital replacement projects. Legislators did the right thing by including this issue in HF 2700; IHA is optimistic the governor will see through the half-truths promoted in various hospital “investigative” reports and sign the measure into law.
