The Mississippi Senate unanimously passed a bill Wednesday designed to help rural hospitals open needed services, joining the House in advancing proposals to support struggling facilities by loosening the state’s certificate of need law. 

“I think we’re moving closer to a consensus about what to do,” Senate Public Health and Welfare Chairman Hob Bryan, a Democrat from Amory and the author of the bill, said of the overlap between each chamber’s proposal. 

The Senate bill would create a pilot program that tasks the state health officer with issuing licenses for three outpatient dialysis units, three ambulatory surgery centers and geriatric psychiatric facilities connected to rural hospitals within five miles of the rural hospital’s main location. The goal is to let hospitals open services that bring in revenue and help them keep their doors open, Bryan said Wednesday. 

The House passed a broader measure on Feb. 4 that would exempt 55 existing rural hospitals from certificate of need regulations, allowing them to open new health services or make improvements within a five-mile radius of their main building without state approval. 

The House and Senate will trade bills for further debate, and they must agree on a final plan before anything could go to the governor.

Mississippi’s certificate of need law requires providers to receive state approval before opening new services or paying for costly upgrades by proving that people need the services in their area. The regulations are meant to lower costs and enhance the quality and accessibility of health care by preventing duplication of services, but stakeholders are divided on whether the law accomplishes its goals. In Mississippi, where more than half of rural hospitals are at risk of closure, some people argue the law harms rural hospitals by restricting the services they are allowed to offer. 

Greg Gibbes is the CEO of five hospitals, including South Central Regional Medical Center in Laurel and Covington County Hospital in Collins. He said he has advocated for a rural exemption from certificate of need law for years because it will allow hospitals to expand the services most needed in their communities. 

“We want to give a small and rural hospital every fighting chance,” he said. “And there are those that are currently struggling that are probably not going to be calling a lot of offensive plays.”

The Senate bill defines rural hospitals as those in a county without a city over 15,000 people or located in Washington County, while the House applies the term to critical access hospitals, those located in Delta counties or in municipalities with a population under 15,000 people. The House bill also would exempt Humphreys and Issaquena counties entirely from certificate of need law.

Crafting effective exemptions to certificate of need laws requires a focus on “very rural” hospitals and parts of the state such as the Delta that require additional support because of workforce shortages and poverty, said Richard Roberson, president and CEO of the Mississippi Hospital Association. 

“We’re trying to make sure we find that sweet spot where we’re allowing hospitals to add services that their communities need in those really rural areas, while also making sure that we’re managing the cost of those services coming online,” said Roberson.

The certificate of need law has long been criticized by health care providers as cumbersome and time-consuming, frequently delaying the opening of new health care services when competing providers appeal the state’s issuance of a certificate. Another bill that passed the Senate Wednesday would require any party requesting a hearing on the state’s decision that loses to pay the fees associated with the hearing. 

Streamlining procedural aspects of the certificate of need process has lowered costs and helped the health department move through applications more quickly in the past, Roberson said. Mississippi enacted a law setting benchmarks for the process’ timeline in 2016. 

He said the Mississippi Hospital Association is weighing the impact of changes to the certificate of need application process, but is open to “anything we can do to lower the cost and make the process better.”

However, Roberson said, the state needs to have some supervision of the addition of new health facilities, especially given the large portion of patients with government-sponsored health plans, like Medicare and Medicaid. 

“It is important to have some oversight of the process to make sure we aren’t spitting up unnecessary or duplicative services that are just going to run up the cost of care for everybody,” Roberson said.  

Mississippi has already enacted one certificate of need reform law this year. Gov. Tate Reeves signed a bill Feb. 4 and it became law immediately, doubling the cost threshold that triggers a requirement for hospitals to seek state approval before making improvements. For clinical improvements other than major medical equipment, hospitals will now require approval for changes over $10 million, up from $5 million. 

The new law also limits University of Mississippi Medical Center’s exemption for a certificate of need to the area around UMMC’s main campus and the Jackson Medical Mall. For years, UMMC has been exempt from certificate of need requirements for facilities or equipment used for education.

Gibbes said if the state Legislature moves to exempt rural hospitals from certificate of need law this session, he doesn’t expect to see a significant increase in services overnight because adding them requires time, labor and funding. But, he said, he believes it is important to create an environment where hospitals that take a risk to offer new services aren’t impeded. 

“These things take time,” Gibbes said. “It’s not like flipping a switch.”