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The Pocahontas Building.

The House Health, Welfare and Institutions Committee met Wednesday to begin studying reforming Virginia’s controversial Certificate of Public Need — or COPN — program.

Delegates heard from state officials and academics on how COPN — essentially a requirement to receive state approval before opening a new medical facility — works in Virginia and other states. It was the only full committee meeting on the topic, according to the committee’s chairman, Bobby Orrock, R-Caroline.

A subcommittee will continue studying the issue in the next year, ahead of the 2019 session, in an effort to better understand how the program works and what changes the state could make.

The certificates are a heavily debated issue in Virginia’s health care landscape.

Those in opposition to the program claim it limits competition and access, while others defend it as protecting hospitals in light of the billions they spend every year providing charity care to state residents.

Matthew Mitchell, director of the Project for the Study of American Capitalism with the Mercatus Center at George Mason University, presented to the committee on the history of such programs.

He said that research shows certificate of need regulations do not help ensure an adequate supply of health care, but that states with such regulations often have fewer hospitals, ambulatory surgical centers, dialysis clinics and hospice care facilities.

Del. Chris Stolle, R-Virginia Beach, made the case that the regulations protect hospitals who provide care to those who are unable to pay, and also accept Medicaid even though the reimbursement rate in Virginia is ranked very low compared with other states.

“So this is lovely theory but when you look at regulations for hospitals who are actually required to see anybody who walks through the door whether they can pay or not versus surgery centers or diagnostic centers, which can choose who they provide care to, the theory doesn’t really meet reality,” Stolle argued.

Mitchell responded by noting that states that do not have certificate of need regulations actually have similar rates of charity care compared with states like Virginia.

He called COPN regulations a “relatively convoluted way” of paying for charity care, and said other states have come up with other options of paying for such care, such as simply reimbursing hospitals.

Orrock said the subcommittee will continue studying the issue to try and determine what would work for Virginia, which has “a lot of unique features,” while also ensuring quality, accessibility and affordability of health care.

“But it is a three-legged stool and you’ve got to keep the stool balanced in that regard, and not let any one of those three rule the roost, as it were,” he said.

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