Important Issues

On Tuesday, Councilmember Christina Henderson with Councilmembers Lewis George, Bonds, Allen, and Parker introduced B25-948, the Certificate of Need Improvement Amendment Act of 2024. The bill is scheduled for a hearing on October 9.

The bill is a long awaited attempt to reform a process that increasingly is forcing independent practices to spend hours and money complying with government requests when making even routine staffing or facility changes.

MSDC is encouraging everyone to testify either during the hearing or in writing after the hearing. To learn more, contact Robert Hay or see the FAQ and talking points document below.

The bill would do the following, according to the Council:

1. Exempt Telehealth: The District is an outlier in its enforcement of the CON process, which was created to regulate the geographic distribution of brick-and-mortar health care services, for virtual provider networks and virtual telehealth platforms. The bill instead requires DC Health to create a registration process for these entities.

2. Exempt office-based primary care and specialist practices: Only 2 other states regulate primary care facilities under CON (NJ, KY) and only 2 other states regulate specialist practices with no operating rooms (VA, GA, KY). This would align the District with other states and encourage more primary and specialist care services to locate in the District.

3. Require biennial updates to the capital thresholds: SHPDA currently has the authority to update the capital expenditure thresholds that would trigger a CON review on an annual basis,  but this  does  not  regularly  occur. This  bill  would  require  SHPDA  to  update  the thresholds every 2 years to accurately reflect inflation and other economic indicators.

4. Exclude nonpatient care capital projects: Currently, health care facilities must submit for  CON  review for  capital  projects not  related  to patient  care,  such  as installing  new elevators, garage improvements, and HVAC upgrades. These reviews can delay necessary repairs  and  upgrades  and  create  unnecessary  costs. This  bill  proposes exempting  these types of nonpatient care projects.  

5. More flexible project timeline: Currently, SHPDA imposes a uniform deadline of 3 years for CON approved capital projects. Facilities have had to restart the process when an active project is taking longer than expected. This bill proposes a more flexible approach to extend the timeline if the applicant is making good faith efforts to meet the schedule.

6. Define “Group practice”: Although the term “group practice” is used in the current D.C. Code, it is not a defined term, which has led to confusion about when a new health care facility must apply for a CON. This bill seeks to clearly define that term.

7. Adjust threshold for number of beds: Currently, SHPDA requires any facility changing its licensed bed capacity to obtain a CON if the change is by at least 10 beds or 10% of total beds, whichever is less. This bill proposes increasing the threshold to 10 beds or 20% of  total  beds,  to  avoid  small  facilities  going  through  a  lengthy  CON  process  for  small changes to their operations.