Montana Proposes Tougher CON Reviews for Surgery Centers Near Critical Access Hospitals

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A bill making its way through Montana's legislature would require any organization wanting to build an ambulatory surgery center in a county with an existing critical access hospital to go through a stricter review process.

House Bill 306 (pdf) would require an organization to apply for a certificate of need and also conduct an impact study to find the financial and operational ramifications of the proposed ASC on existing healthcare facilities, such as CAHs, in a county with 50,000 people or less. Applicants will also have to pay for the impact study and provide an opportunity for public comment on the proposal, among other stipulations.

If Montana finds the proposed ASC would adversely affect the CAH in the county, the state would either deny the CON or "impose conditions on the applicant…to mitigate the adverse impact."

CAHs praised the bill, sponsored by Rep. Ron Ehli (R-Hamilton), saying it would prevent ASCs from draining profits from their organizations that are used to pay for less profitable and essential service lines, such as emergency care, according to a Missoulian report.

Larger hospitals and health systems opposed the bill. Kalispell (Mont.) Regional Healthcare, one of the largest systems in the state, said the bill would make it difficult for them to expand their ASC services in rural areas, according to the report.

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