CHARLESTON — The West Virginia House of Delegates will once again decide whether to keep the state’s certificate of need system in place or abolish it.

The House Health and Human Resources Committee recommended for passage Tuesday House Bill 4909, relating to eliminating the certificate of need program for health services, in a 13-9 vote. The bill will now head to the full House for consideration.

HB 4909 would eliminate certificate of need (CON) requirements for all healthcare services except hospice care services. The bill’s lead sponsor is House Health Committee Chairwoman Amy Summers, R-Taylor, who has long been a proponent of eliminating CON in the state.

States began implementing CON programs 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.

According to the National Conference of State Legislatures, only 12 states have fully repealed their CON programs.

Supporters of repealing CON believe that ending the program will give residents more options for health care, increase the number of rural hospitals in the state, provide more savings in health care costs and possibly save more lives.

An example is the Eastern Panhandle, where WVU Medicine operates the Berkeley County and Jefferson County medical centers. Committee members heard from representatives from Valley Health that operates the Winchester Medical Center across the border in Virginia.

Valley Health would like to operate a neighborhood hospital in the Eastern Panhandle, defined as a small hospital with a limited number of emergency room bays and inpatient beds. Chris Rucker, the chief of staff for Valley Health, told committee members that his company has not filed their CON application with the West Virginia Health Care Authority because current CON regulations don’t address the creation of neighborhood hospitals.

“Building a second large hospital doesn’t necessarily serve the interests of the community, but having additional access points with an emergency room and a place to be able to hold patients for two-to-three days and care for lower acuity patients would help address needs,” Rucker said.

Opponents of CON repeal include the West Virginia Hospital Association, which believes the current CON process ensures that regions of the state have appropriate levels of health care and helps protect rural hospitals from unfair competition.

“If you eliminate CON, basically you can have organizations from outside of the state come in, cherrypick services, and usually what you’ll see is them going after commercial-pay patients, leaving institutions with the Medicaid and uninsured population,” Jim Kaufman, president of the West Virginia Hospital Association. “What you’ll see is the entire health delivery system undermined.”

The Legislature has taken smaller bites at CON over the years, choosing to exempt certain health care services from CON requirements. An attempt in 2022 by some House Republicans to fully eliminate CON failed in a 10-12 vote in the House Health Committee.

That bill’s lead sponsor was also Summers – then the House Majority Leader – and supported by Del. Heather Tully, R-Nicholas, who now is vice chair of the House Health Committee.

Speaking in favor of the bill, Tully said it is not fair for one healthcare entity to hold on to a certificate of need if there is a need for additional services in a community while having the ability to oppose another provider’s CON request.

“I don’t think you should get to make an application one time and hold onto that application or that certificate of need forever when probably you aren’t meeting the scope of services that you initially outlined in the application,” Tully said. “I think that is very concerning. I think it’s concerning that we don’t look at the diversions and bed closures and changing of staffing levels.”

Del. Scott Heckert, R-Wood, said he would not support the bill. While he understood the concerns of some regions where shortages of beds and staff have caused diversions of patients to other facilities, Heckert believes a full repeal could cause a flood of unneeded services crowding out established providers.

“We’ve already got staffing issues that cause the deferments that we’ve all been talking about and putting more stress on the system,” Heckert said. “There’s a way to go about it, but opening the gate and just letting anybody come in is not the way to fix this problem.”