House Majority Leader Amy Summers introduced several amendments to repeal certificate of need requirements. (Photo Provided)

CHARLESTON — A bill to provide an exemption to West Virginia’s Certificate of Need law became a vehicle Tuesday for opponents to make an unsuccessful attempt to repeal the entire program.

Delegates considered multiple amendments to House Bill 4643 on Tuesday afternoon, exempting certain health services from Certificate of Need requirements. HB 4643 would exempt the construction, development, acquisition, and establishment of birthing centers from CON.

The bill is now on third reading and up for passage later today.

CON rules are designed to help control health care costs and prohibit duplicative or unneeded medical services in communities. West Virginia’s CON law was put in place by lawmakers in 1977, making it one of 35 states with CON laws.

House Majority Leader Amy Summers, R-Taylor, offered several amendments to the bill, including an amendment to completely repeal CON which was pulled due to technical issues with the amendment. Summers was the lead sponsor of a CON repeal that failed on a 10-12 vote in the House Health and Human Resources Committee earlier this month.

Del. Riley Keaton said amendments to repeal certificate of need would hurt rural hospitals. (Photo Provided)

Summers, an emergency room nurse, also offered amendments Tuesday to exempt everything except skilled nursing homes, home health programs and hospice care; to exempt everything except hospice, home health, ambulatory care centers, kidney disease treatment centers and intellectual disability services; and exempting birthing centers, surgical services, inpatient care, and expansion of care or capital expenditure changes from CON.

All three amendments failed.

Several delegates raised concerns about how the amendments would affect critical access hospitals located in rural parts of the state. According to the West Virginia Hospital Association, the state has 21 critical access hospitals, a designation given by the Centers for Medicare and Medicaid Services for rural hospitals that provide vital services.

“Your vote on these amendments … is a vote on your hospital’s access to capital, on its solvency if it comes down to it,” said Delegate Riley Keaton, R-Roane. “If you want to secure current future investments in our state’s hospital system and the healthcare that our people depend on, you need to be a no.”

“When you look at the states that don’t have Certificate of Need, these concerns do not come to fruition,” Summers said in response. “I just have a hard time sometimes understanding why anyone wants to allow any barriers to healthcare in West Virginia, because we need more services.

“We have an over-regulated healthcare marketplace,” Summers continued. “The prices have increased faster than inflation. The quality metrics are low. And we don’t want to offer any other services unless they go through this process, but when they go through this process their competitor gets to weigh in and say ‘we don’t want that.'”

The Democratic members of the House stayed out of the debate on the three amendments offered by Summers with Republican House members debating for or against the various amendments. Nicholas County Republican lawmaker and fellow emergency room nurse Heather Tully supported Summers’ amendments.

“I think what we’ve seen is the Certificate of Need is a competitor’s veto,” Tully said. “It is heavily influenced by political relationships, providers’ clout, organization size, and overall wealth and resources, rather than sound public policy objectives and concern for patients.”

“Having options is good for West Virginia,” said Delegate Wayne Clark, R-Jefferson, who has to take his wife and daughter out-of-state to receive the healthcare they need. “We need to give people options.”

While supporters of the Summers amendments said repealing CON would open up healthcare to the free market, opponents argued that the federal Affordable Care Act has destroyed the free market for healthcare and CON would not reverse that.

“Certificate of Need is a protection for the people in the State of West Virginia. It’s a protection for our healthcare,” said Delegate John Kelly, R-Wood. “Our healthcare needs some competition … but I don’t believe the Certificate of Need is quite the place to bring that competition.”

Larry Pack, a Kanawha County Republican delegate and CEO of Stonerise Healthcare Transitional Care, said healthcare prices are determined by payers, such as Medicare, Medicaid, the state Public Employees Insurance Agency, and private insurers.

“There is no free market in healthcare,” Pack said. “There is no competition here in price. Medicare tells the hospitals what they’re going to pay them. Medicaid tells the hospitals what they get. PEIA tells the hospitals what they get … this is not about the free market at all.”

Another failed amendment, offered by Delegates Brandon Steele, R-Raleigh, Mick Bates, R-Raleigh, and Mike Pushkin, D-Kanawha, would have required birthing centers to have at least $1 million in liability insurance for each provider and at least $3 million in liability insurance per facility. The amendment would have rendered any hospital or physician immune from liability if they treat birth complications caused at a birthing center.