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    Competition-stifling facility regulations scrutinized nationwide

    Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or [email protected] for more information.

     

    In 1964, New York lawmakers enacted the first state statute granting regulators the power to determine a community's "need" for new hospitals and nursing homes. Ten years later, the federal government stepped in, requiring all 50 states to create an agency to review "capital projects such as building expansions or ordering new high-tech devices," according to the National Conference of State Legislatures.

    Related: Increased use of telehealth prompts heightened legislative activity

    Supporters of "certificate of need" (CON) laws argued that limiting new facilities and services would reduce inefficiencies and minimize excess capacity. When the restrictions failed to reduce costs, established providers changed their rationale. They instead argued that the state must limit the growth of specialty hospitals and ambulatory surgery centers to ensure that privately insured patients do not abandon hospital settings, which depend on private payer beneficiaries to make up for losses associated with Medicare and Medicaid reimbursement.

    Certificate of need health laws by state

    Overwhelmed by insufficient evidence of their usefulness and the tide of Reagan-era deregulation, the federal health facilities planning mandate was repealed in 1987. Within 10 years, 14 states eliminated their certificate of need programs. In the intervening period, most states have tweaked their laws, whether adding new technologies under the CON umbrella or, to loosen the noose, increasing the capital expenditure threshold at which regulators must review a project. But 36 states still impose restrictions in the hope of reducing costs and limiting duplication of services.

    Next: Imaging technology restricted in at least 20 states

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