Senate committee recommends HB 1393 substitute to repeal most certificate-of-need rules and narrowly grant antitrust immunity to rural hospital authorities

The Senate Health and Human Services Committee on Wednesday voted 8–5 to recommend a substitute to House Bill 1393 that pairs a broad repeal of certificate-of-need regulations with a narrowly drawn antitrust immunity for qualifying rural hospital authorities.

The substitute, explained to the committee by attorney Josh Belafonte, removes CON requirements for most providers except skilled nursing facilities and creates a new statutory article that defines when a hospital authority can be treated as a state actor for antitrust purposes. "The idea is if you're going to do that to allow this kind of cooperation, that can be as narrow as possible," Belafonte said, describing limits that would confine immunity to entities that operate only in rural counties and are affiliated with no more than two other hospitals.

Why it matters: Backers say repealing CON will remove barriers that prevent new providers and services from entering communities, particularly rural ones, and that a careful immunity definition will let small hospitals collaborate on shared services without letting large systems gain a backdoor entry. Opponents warned the repeal could reduce oversight that protects patients and local hospitals.

Economist Ailey Geddes, testifying in her personal capacity as an assistant professor at the University of Georgia, told senators that the empirical literature does not show CON laws reliably lower costs and that, in many cases, they reduce capacity and access. "The empirical research on this particular benefit finds little evidence to support the claim that certificate of need regulations lower costs in practice," Geddes said, citing meta-analyses and reviews.

Legal advocate Jim Manley of the Pacific Legal Foundation said the CON process often permits incumbents to block new entrants and cited examples of approvals delayed for years. "These are regulations that are not related to public health or safety. They're simply aimed at protecting existing health care providers from competition," Manley said.

Hospital representatives expressed mixed views. Jesse Wetherington of the Georgia Association of Health Plans said many antitrust concerns had been mitigated in the substitute and urged support. Anna Adams of the Georgia Hospital Association said her group opposes a complete repeal of CON except for nursing homes and sought further compromise.

Several committee members pressed for tightened language to prevent large systems from qualifying for immunity via affiliated physician groups and discussed including a prohibition on noncompete agreements for entities that opt into immunity. Belafonte said the language can be narrowed and the bill remains open to drafting changes.

Formal action: The committee voted 8–5 to recommend the substitute. A committee member characterized the motion as a "do pass" recommendation; the motion was seconded and carried. The committee record shows the substitute will proceed in the legislative process for further consideration.

What’s next: Committee members signaled an intent to continue refining the statutory definitions and administrative procedures (including a 180-day attorney-general review and a 35-mile notice radius for nearby providers) as the bill moves forward.

Ending: The committee adjourned the HB 1393 session after the vote; the substitute will move onward in the legislative process.