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Health Law
University of Mississippi School of Law
Gilchrist, Katie

 Health Law–Gilchrist
Fall 2007
 
I.                    Certificate of Need Laws
**In MS, in order to obtain a new service or open a new facility, a certificate must be granted to the proprietor by the Mississippi Department of Health recognizing that there is a need for that service or facility in the area
 
A.     National Health Planning and Resource Development Act-(1974)—(federal act)—at this time, hc was under a system of cost-based reimbursement—by controlling providers Medicaid/Medicare could control the amount it was paying by cutting off providers
                                                               i.      Legislative intent: to require preapproval of major healthcare svcs. and equipment to:
a.       Insure quality health
b.       Increase access of healthcare to indigents nationwide
c.       Control Costs
                                                             ii.      Requirements: By 1980, q state had to have a CON law in place
                                                            iii.      Government repealed this act in 1987—Followed end of cost-plus reimbursement (studies indicated that CON laws were doing the opposite of what they were intended to do—ex. a study in 1998 showed CON laws led to a 2% reduction in availability of hospital beds, higher cost per day for inpt. care, higher costs per admission and also led to higher profits by these organizations).
a.       15 states repealed CON laws
b.       35 (including MS) still have them
                                                           iv.      In 1992, FTC issued stmt. that CON programs pose serious economic concerns and that consumers would be better served if CON laws repealed (20% increase in hospital spending)
B.     Economic and Health Factors in MS contribute to the need for controlling quality and costs so that all of the indigent population are cared for . . .
                                                               i.      Economic Factors
a.       MS ranks 48th in median household and family income
b.       16% of MS families live below the poverty level
c.       22% Mississippians have no health insurance
d.       22 counties with double-digit unemployment rates (2004)
                                                             ii.      Health Factors
a.       Highest percentage of births to “at risk” mothers
b.       Highest rate of adult overweight and obesity
c.       Exceed the national new case rate of TB each year
d.       Highest prevalence for diabetes (21% higher)
e.       One of 11 states in “stroke belt.”
f.        In MS, there are not enough hc providers to care for people—61 of 82 counties designates as healthcare shortage areas (only 1 PCP for q 1400+/- people, six counties w/ only one dentist, 1 doctor for q 588 people
C.     MS CON Process Governed by:
             

ic testing facilities—except MRI’s (have to have CON for MRI regardless for whatever)
                                                            iii.      Relocation of a health care facility or portion thereof, or major medical equipment:
a.       Unless within a mile
b.       Costs less than Capital Expenditure Threshold
                                                           iv.      Any change in existing bed compliment of any healthcare facility
                                                             v.      The following always require CON (unless already provided in last 12 mos.):
a.       Open Heart Surgery
b.       Cardiac Catheterization
c.       Skilled Nursing Beds
d.       Home Health Services
e.       Comprehensive Inpatient Rehabilitation Services
f.        Radiation Therapy
g.       MRI/PET
h.       ASC
i.         LTAC Services
j.         Invasive Diagnostics
k.       Swing Beds
l.         Licensed Psychiatric/Chemical Dependency Services
                                                           vi.      Relocation of one or more health services (unless within a mile, under cap. expenditure)