The U.S. Healthcare Certificate of Need Sourcebook
By Robert James Cimasi, ASA, CBA, AVA, FCBI, CM&A, CMP
2005/10 - Beard Books
1587982757 - Paperback - 512 pages
US$199.95
Healthcare providers, both institutional and non-institutional, whether
for-profit or not-for-profit, will find this work to be a vital part of their
libraries.
Certificate of Need (CON) has had a broad impact on healthcare providers and
markets for over three decades. As the bibliographies and other resources in
this book illustrate, there is a large amount of literature documenting CON
regulation over the years. However, the literature is sporadic in its coverage
of certain key aspects of CON including: directories and data for individual
state CON programs and their impact, private studies on CON, legal and case law
analyses, and several other areas. This work is the result of over two years of
dedicated, focused research resulting in a comprehensive reference manual and
sourcebook encompassing the statutory, regulatory, administrative, and legal
aspects CON regulation from its inception in the late 1960s to the present.
The U.S. Healthcare Certificate of Need Sourcebook provides detailed
descriptions, on a state-by-state basis, of CON regulatory requirements,
including application thresholds, contact information and utilization data.
Comprehensive bibliographies are also included with thousands of published
monographs, serials, professional and trade journals, as well as general press
articles, research studies, published case law, law review articles, and bar
journal coverage of CON. The work also includes compendiums of Internet-based
and other data resources, a thorough glossary of CON terminology, and reviews of
major research organizations and economists. The book is supplemented with
numerous appendices. Based on a proprietary database, the work is designed to
support periodic publication updates.
The U.S. Healthcare Certificate of Need Sourcebook is unique in its
scope and comprehensive treatment of the topic of CON, which is a growing and
increasingly contentious competitive, political, and legal healthcare policy
issue.
FOREWORD
As a young attorney in the general counsel’s office of the U.S. Department
of Health and Human Services during the late 1970s, I first learned of the
federal government’s quixotic efforts to rein in the rapid growth of our
nation’s healthcare industry. With its whimsical acronyms and labyrinth of
regulatory protocols, the Certificate of Need (CON) program became my ticket out
of government service into the private practice of law. Indeed, for much of the
next ten years I found myself in the middle of a fierce battle between
regulators and competing healthcare organizations fighting over who should
receive the government’s franchise for the newest technology or facility to
put it in.
Looking back from the vantage of today’s healthcare system, it seems
remarkable that at one point almost every state had some form of CON program and
had accepted the premise that governments could do a better job of matching
supply and demand than the healthcare marketplace. Although a large number of
states have either abandoned or fundamentally revised their CON programs, where
they exist, CON programs remain a major hurdle for providers seeking to expand,
modernize or reshape their service capabilities.
Success in scaling this hurdle requires a combination of resources including
the expertise of professionals like Bob Cimasi who have dedicated their careers
to understanding the inner workings of the regulatory process and its effect on
the private sector.
When CON was a larger part of my legal practice than it is today, there was
no single source containing a reliable summary of each state’s law and how it
has been interpreted and applied. Nor was there a directory of the contact
people who ran the CON programs or were available for consultation or
representation on a project. Those of us who did quite a lot of this work
treated such information as highly proprietary and only shared it with our
clients. Mr. Cimasi’s book The U.S. Healthcare Certificate of Need Sourcebook
fills that void in the literature and provides a useful research tool for both
the neophyte and seasoned professional.
Healthcare providers, both institutional and non-institutional, whether
for-profit or not-for-profit, will find this work to be a vital part of their
libraries. Having had the pleasure to work with Bob Cimasi on many occasions, I
know first-hand the depth of his knowledge and experience with complex subjects.
I am delighted that he has taken the time to share some of
his wisdom through this excellent book.
Peter A. Pavarini, Esq.
Schottenstein, Zox & Dunn
September 2004
From Nightingale's Healthcare News, Review by Henry Berry:
Established more than 30 years ago by the federal government and state
governments, the Certificate of Need (CON) program was intended to be a primary
way to control healthcare costs by regulating major capital expenditures and
modifying healthcare service capacity. According to the author, the CON program
is based on the premise that, “in an unregulated market health-care providers
will provide the latest costly technology and equipment, regardless of
duplication or need.”
With healthcare costs continuing to rise inexorably, CON programs are being
reconsidered and reviewed by federal and state regulators and healthcare
agencies. The CON program is still used by most states to control healthcare
costs, although some states have abandoned the program or substantially modified
it. The number of states with CON programs peaked at 49 in 1980 and remained in
the high 40s for most of the 1980s. In 1988, the number dipped to 39 and has
held steady in the high to mid 30s since then. In 2004, the number was at 36.
Regardless, the CON program has significantly affected the delivery of
healthcare in this country and still does.
The U.S. Healthcare Certificate of Need Sourcebook is encyclopedic in scope
and content, which reflects the author’s breadth of knowledge about the
subject matter. For over 20 years, Cimasi has helped clients in nearly every
state understand and comply with the requirements of the CON program. He is a
leading authority on CON issues, practices, procedures, regulations, and
standards, and he has an incomparable background in healthcare consulting,
litigation, and mergers and acquisitions.
Cimasi draws upon his formidable experience and his record of helping healthcare
businesses adapt to market and regulatory changes to present a great amount of
information, cases, and developments relating to the CON program.
The book offers readers an overview of CON program basics and a history of
its development. This overview is complemented with a discussion of federal and
state court cases and state administrative cases and decisions affecting the
program’s application. The author’s treatment of these cases is thorough –
the cases categorized by states alone cover nearly 120 pages. The multitude of
state cases are cited and annotated according to different levels of state
courts, and also by their underlying causes of action and classification of
regulated asset. For example, 20 underlying causes of action are offered under
seven headings. The classifications for causes of action include procedural due
process violations, arbitrary CON board decisions, establishment/challenge to
new need requirements for state health plans, and definition of regulatory
terms. The classifications for regulated assets include medical equipment such
as magnetic resonance imaging and computerized tomography; ambulatory surgery
centers; cancer treatment centers, dentist offices, hospitals, and other
facilities; and services, including ambulances, cardiac catheterization, and
dialysis.
While the book is extraordinarily comprehensive in its treatment of the
subject matter, it is also interactive and user friendly. From his experience
with clients, Cimasi understands what is most important to impart to readers
about the numerous cases cited throughout the book. The utility of this work is
reflected in the “abstracts” of each case. The abstracts are categorized by
state and include complete, consistent identification of each case according to
standard legal annotation. Each abstract describes the grounds of the action,
states the findings of the court, and gives the court’s decision. For example,
a sample abstract of the 1987 case Platte County Medical Center Inc. v. Missouri
Health Facilities Review Committee describes the circumstances leading up to a
final decision by an appeals court – “Denied applicant appealed to the
Circuit Court, Cole County after Committee denied its applicant for CON” –
along with other specifics of the case. The finding of the appeals court, which
ended the litigation, was that the “Committee’s failure to issue decision in
a timely manner (under 120 days) indicated approval of CON.” This information
is useful for readers not only for decisions in particular states, but also for
rulings for compliance with CON statutes and regulations by both healthcare
organizations in the private sector and the government.
Cimasi’s book offers several other resources. One is a bibliography of
hundreds of books and articles on CON. The Sourcebook also lists CON statutes
and regulations by state and contact information for state agencies responsible
for program implementation. Useful websites are also provided.
This thorough guide and reference is invaluable to anyone who will be or is
involved in the CON program in any of the states where it is still in place.
Readers will also find it uniquely informative on government policies concerning
healthcare.
From Leo Uzych, JD MPH, Journal for Healthcare Quality Web Exclusives, May/June 2006:
Key Words: government regulations, public policy, resource utilization
This book is a great resource for certificate of need information; it contains resource-related materials and addresses concerns related to certificate of need. An introductory section discusses some of the historically pivotal and troublesome aspects of statutory and regulatory-laden certificate-of-need schemes. The reference materials should be helpful to those seeking to disentangle the knotty mass of regulatory and legal issues addressed by the
certificate of need statutes and regulations of particular states.
The certificate of need resources, the substance of the sourcebook, are listed in several bibliographies, including one of books, reports, and working papers; a second of relevant articles; and a third of law cases by case name. Abstracted law cases, arranged by legal venue, are another resource in the sourcebook. A listing of law cases, arranged according to the nature of the underlying legal cause of action and linked with particular healthcare equipment, facilities, and services, is another resource. In addition, a listing by state will help users determine whether particular types of healthcare equipment, facilities, and services are subject to
certificate of need regulation.
For those seeking answers to particular real-life problems related to certificate of need, the resource materials in the sourcebook may be generally instructive. However, statutes, case laws, and regulations that impinge on the
certificate of need mechanisms of individual states may change over time, thus eroding the timeliness and potential helpfulness of the sourcebook. The fragmentation and decentralization of the U.S. healthcare system may lessen the practical value of resource materials in this book. In any case, this reference should not be used as a surrogate for the counsel of qualified professionals regarding specific problems or issues pertaining to certificate of need.
From John M. Callahan, Esq.
Partner, McDermott Will & Emery, LLP:
The (U.S. Health Care) Certificate of Need Sourcebook is as insightful
as it is comprehensive. A must-have resource for the business or legal
professional who plays in the health care arena.
From Doreen Dodson, Esq.
Partner, The Stolar Partnership:
The U.S. Healthcare Certificate of Need Sourcebook is a welcome new
resource for health law attorneys working with CON. Its comprehensive treatment
of the subject is a valuable practice aid.
From Keith Borglum,
Principal, Professional Management and Marketing:
Finally, an urgently-needed comprehensive guidebook on a difficult topic from
a trusted source. This book fills a gap in the libraries and knowledge-base for
those of us wresting with CON issues. The contact-list alone is invaluable!
From David Edward Marcinko, MD, MBA, CFP, CMP,
Chief Executive Officer, Institute of Medical Business Advisors:
When I founded an ambulatory surgery center more than two decades ago, I was
told a Certificate of Need (CON) was required, but knew little about
governmental rules and regulations. In response, my local hospital embarked on a
ferocious battle to thwart our mission. The Sourcebook would have helped. My
suggestion is to read this valuable resource and reap the benefits.
From Jacque Sokolov, MD
Chairman Sokolov Sokolov Burgess:
The U.S. Healthcare CON Sourcebook is a critical resource for any healthcare
planner in a time of 'shifting CON sands' in many states. Understanding where
CON is and where it may go can make or break key decisions at the hospital or
physician level.
From Alan H. Pierrot, M.D.
Chief Executive Officer, FSC Health Inc.:
Physicians know CON as a policy that entrenches the status quo, stifles
competition and innovation and fails the patients it professes to serve. This
carefully researched work provides the facts to overturn it state by state.
From John E. Hennessy, CMPE
Executive Director, Kansas City Cancer Centers:
Bob's expertise in Certificate of Need helped Kansas City Cancer Centers
develop two cancer centers and one PET/CT project in a CON state, despite
sometimes heavy opposition from competitors. Anyone who operates in a CON state
can benefit from this book, whether you intend to pursue capital projects or
not.
From Leo Sands
Executive Vice President and Chief Administrative Officer, U.S. Oncology:
Over the years, Bob Cimasi and Health Capital Consultants (HCC) have compiled
a wealth of research and information on the subject of Certificate of Need
issues related to states across the U.S. Their experience and background in
assisting U.S. Oncology and other clients with their consulting services in this
important area makes the The U.S. Healthcare Certificate of Need Sourcebook
a welcome addition to the resources on CON available to healthcare providers and
their professional advisors.
Robert
James Cimasi, ASA, CBA, AVA, FCBI, CM&A, CMP is President of Health Capital
Consultants (HCC) with over twenty years of experience in serving clients, in
over forty five states, with a professional focus on the financial and economic
aspects of healthcare service sector entities including: valuation consulting;
litigation support; business intermediary and financing services; certificate of
need consulting; and, healthcare transactions including sales, mergers, and
acquisitions. Mr. Cimasi holds the Accredited Senior Appraiser (ASA) designation
in Business Valuation, as well as, the Certified Business Appraiser (CBA),
Accredited Valuation Analyst (AVA), Certified Business Intermediary (Fellow) (FCBI),
the Alliance of Merger & Acquisition Advisors CM&A, and the Certified
Medical Planner (CMP) designations.
Mr. Cimasi is a nationally known speaker on healthcare industry topics, who
has served as conference faculty or presenter such organizations as the American
Society of Appraisers (ASA), Institute of Business Appraisers (IBA),
International Business Brokers Association (IBBA), American Institute of
Certified Public Accountants (AICPA), Academy Health, Healthcare Financial
Management Association (HFMA), American College of Healthcare Executives (ACHE),
National Association of Healthcare Consultants (NAHC), National CPA Health Care
Advisors Association, National Litigation Support Services Association (NLSSA),
and many other national and state healthcare companies and organizations, as
well as industry associations and professional societies.
He has been certified and has served as an expert witness on cases in several
states, and has provided testimony before federal and state legislative
committees. He is the author of A Guide To Consulting Services for Emerging
Healthcare Organizations (John Wiley & Sons, 1999), The Valuation of
Healthcare Entities in a Changing Regulatory and Reimbursement Environment (IBA
Course 1011 text - 1999), and of An Exciting Insight Into the Health Care
Industry and Medical Practice Valuation (AICPA Business Valuation course
text 1997, rev. 2004.) He has written chapters on medical practice valuation in The
Handbook of Business Valuation (John Wiley & Sons), Valuing
Professional Practices and Licenses: A Guide for the Matrimonial Practitioner,
3rd ed., 1999 (Aspen Law & Business), and Valuing Specific Assets in
Divorce (Aspen Law & Business) and has been a contributor to The
Guide to Business Valuations (Practitioners Publishing Company) and Physician’s
Managed Care Success Manual: Strategic Options, Alliances, and Contracting
Issues(Mosby). Photo from the HHC website.
1. Disclaimer
2. Dedication
3. Preface
4. Acknowledgements
5. About the Author
6. Foreword
7. Table of Contents
Background and Quick Reference Information
8. CON Narrative History and Background
9. States with CON Programs
10. State CON Status Maps
11. Contact Information – Regulatory / State Agencies
12. Contact Information – Research Groups
13. Leading CON Healthcare Economists
14. CON Related Websites
Bibliographies of CON Related Resources
15. Book Bibliography
16. Article Bibliography
17. CON Case Law Bibliography
Case Law Indexes
18. CON Case Law Table of Cases – Indexed by State
19. CON Case Law Table of Cases – by Underlying Cause of Action
20. CON Case Law Table of Cases – Indexed by Classification of Regulated Asset
State by State Regulatory Data Analysis of CON Programs
21. State CON Statutes and Regulations
22. Application of CON Laws to Assets and Services by State
Robert
James Cimasi, ASA, CBA, AVA, FCBI, CM&A, CMP is President of Health Capital
Consultants (HCC) with over twenty years of experience in serving clients, in
over forty five states, with a professional focus on the financial and economic
aspects of healthcare service sector entities including: valuation consulting;
litigation support; business intermediary and financing services; certificate of
need consulting; and, healthcare transactions including sales, mergers, and
acquisitions. Mr. Cimasi holds the Accredited Senior Appraiser (ASA) designation
in Business Valuation, as well as, the Certified Business Appraiser (CBA),
Accredited Valuation Analyst (AVA), Certified Business Intermediary (Fellow) (FCBI),
the Alliance of Merger & Acquisition Advisors CM&A, and the Certified
Medical Planner (CMP) designations. 
