Government regulation of health facilities construction: certification-of-need laws and the implications for architects
Ash, Lee Roy
Douglass, H. Robert
Master of Architecture
Today's architect is in a position unknown by those who have gone before him in the architectural profession. He now finds himself in the position of expanding his services to his clients or risk losing those clients completely. Nowhere is this more evident than in the dynamic and expanding health field At the forefront of such change in the health facilities construction field is the growing concern with rising health care costs due in part to the uneven distribution and therefore uneven access to health facilities. This concern is placing emphasis on the needs within the health system as they relate to facilities planning. The result of^^his concern is the enactment, by many states, of certification-of-need laws. These laws date back as far as 1964 with an initial interest in 1959. Until 1973, certification-of-need had been handled on a state by state basis. However, in 1973, the federal government, by way of the Social Security Amendments, P.L. 92-63, added Section 1122 to title XI of the Social Security Act. This legislation gave federal support to the state legislation through the allocation of federal money. The coverage and administration of certification-of-need laws vary from state to state, but generally apply to health facilities construction which changes the number of beds in the facility, changes the services of a facility or is in excess of a stated dollar figure. The review and appeals processes, including the criteria for such processes, also vary greatly from state to state. However, despite these variations, the same legal basis and legal problems are typical in each state. The architect who proposes to assist his client in securing a certificate-of-need must be aware of his clients' viewpoints concerning this legislation in order to successfully serve his client. Viewpoints in favor of, and. in opposition to, certificate-of-need are numerous and are directly related to the client's role in the medical field. Besides an awareness of his clients' viewpoints, the architect must understand the implications of these laws upon his practice. Through interviews with architects who have dealt with this law, a number of implications can be noted. Certification-of-need will undoubtedly change the scope of services of the architect who does health facility work. More important, it can be used as a marketing concept for the ambitious architect. Other areas of the architectural practice which will be affected are office organization and management, especially concerning time and use of personnel, the relationship between the architect and his client, both in communications and financially, and in the architect's public representation of his client. Also affected by certification-of-need will be the architect's political involvement and his concern with additional legal, liabilities. An additional responsibility which the architect will incur through certificate-of-need is the impact he can have upon this law both prior to and following its enactment. Certification-of-need, therefore, is a law which must be dealt with not only by the medical professions, and health planners, but also by the architectural profession.