Certificate of Need, licensing requirements could be cut in Iowa

A broad-ranging piece of legislation introduced this week could make significant changes to the state's health care system.

The 82-page bill put forth by Gov. Terry Branstad would weaken the Certificate of Need program for hospitals as well as eliminate licensing requirements for a wide number of professions, from social work to mental health counselors, boards and commissions. Much still is unknown about the bill, but affected groups worry the bill could hurt hospital budgets and negatively impact some providers' ability to receive insurance reimbursements.

'In his Condition of the State address, Gov. Branstad asked the legislature to take a comprehensive review of all of our state's boards and commissions to address unnecessary barriers that prevent competition and raise costs on Iowans,” said Ben Hammes, Branstad's spokesman, in an email. 'Thirty-three percent of Iowa's workforce is licensed - the highest in the nation - and we felt it was time to have an initial conversation about licensing reform.”

Hammes added that occupational licensure should be narrowly targeted to ensure health and safety, but that the state should work to remove barriers of entry for those seeking employment, lower the costs of regulation on businesses, and reorganize boards and commissions to improve inefficiencies.

But the bill might run into issues in the statehouse.

'Frankly, I have big problems with the bill,” said Rep. Bobby Kaufmann, R-Wilton, who will chair the subcommittee discussing the bill, HSB 138, on Monday afternoon. 'I'm not inclined to move forward the legislation, but I want to listen to both sides before I make any decisions. More people have called me about this issue than any other issue in my entire legislative career.”

Certificate of Need

Certificate of Need is a regulatory review process in which hospitals and other medical providers must go before a state board for approval to offer new services or purchase medical equipment costing more than $1.5 million. Thirty-four states have some form of a CON program, and Iowa's has been around since 1977.

Mercy Medical Center and UnityPoint Health-St. Luke's Hospital have both gone before the board in recent years - Mercy asking to provide open-heart surgery and St. Luke's looking for approval to offer radiation services.

It can be a cumbersome process, but Iowa's Hospital Association says it's a necessary one.

CON prioritizes community-based health care and ensures financial stability for hospitals, said Scott McIntyre, spokesman for the group that represents the state's 118 hospitals. Getting rid of CON could 'open the door to the Wild West,” he said.

Hospitals offer lots of services, some of which are more profitable than others, such as imaging and child delivery. These services help balance out the charity or uncompensated care they provide and the low reimbursement rates they often receive for Medicaid patients.

If CON goes away, hospitals worry that providers will pop up and lure patients away to specialty centers. This could hurt their bottom lines and make it harder to offer necessary services to those who may not be able to afford it.

'CON is doing exactly what it says it's going to do,” McIntyre said. 'It examines and makes a finding of need for the community. It's done across the board, all the services covered under CON have to show that need.”

But critics, including Branstad, say the program hurts competition.

'The established health care provider uses this as a way to keep out competition,” Branstad told The Gazette back in August.

But McIntyre said that more health care does not equal better health care.

'It could change the way the health care system works in Iowa and the culture in Iowa,” McIntyre said. 'There is a great deal of collaboration between hospitals and other providers. If you worsen an element that focuses of making profit, making money, that changes the culture.”

Licensing

The legislation also would take away licensing requirements for 10 professions - including audiologists, social workers, marital and family counselors, and mental health counselors - instead requiring professionals having only to register with the state.

That slight change in wording could produce huge consequences, those affected said.

Licenses require individuals to achieve certain education and training as well as maintain ethical standards. Moving toward a system in which one only has to pay a fee and register means there's less oversight, said Donald Gilbert, a Des Moines-based mental health counselor and president of the Iowa Mental Health Counselors Association.

'If you're registered, you can just say, oh yeah, I did those things,” he said. 'There's a process by which (the boards) deal with complaints ...

. This diminishes the ability to serve needs of the people.”

The various groups have worked more than 20 years to first have Iowa require professional licenses and then to get insurers to reimburse licensed professionals for their services. Getting rid of these requirements now would move the state backward, he said,

'All 50 states have licensure, and now we're going to go backward?” he said 'This does not look good for Iowa.”

The legislation could push those in these professions to work in surrounding states, he said, and further hinder recruitment efforts.

What's more, it will hurt Iowans seeking services. If a counselor is not reimbursed by private insurers or the federal government through programs such as Medicaid and Tricare - health care for veterans - they can't work with those patients.

'Everyone will be affected,” he said. 'I have a six-year old grandson who is autistic - without these services, he wouldn't be able to talk today.”

l Comments: (319) 398-8331; chelsea.keenan@thegazette.com