Certificate-of-need laws and substance use treatment

Area of Science:

• Health Services Research
• Public Health Policy
• Substance Use Disorder Treatment

Background:

• Certificate-of-need (CON) laws mandate healthcare providers prove service necessity for operation or expansion.
• While common for hospitals, CON laws also apply to other services, including substance use treatment in 23 states as of 2020.
• Substance use treatment CON laws, unlike those for hospitals, remain understudied regarding their impact on access and cost.

Purpose of the Study:

• To investigate the impact of state-level Certificate-of-need (CON) laws on access to substance use disorder treatment.
• To analyze how CON laws affect the availability of substance use treatment facilities and beds.
• To determine the effect of CON laws on the acceptance of Medicare and private insurance by treatment providers.

Main Methods:

• Utilized data from 2002-2019 on substance use treatment facilities from the National Survey of Substance Abuse Treatment Services.
• Employed fixed-effects analysis to assess states that enacted or repealed substance use CON laws.
• Measured the influence of CON laws on the number of facilities and beds per capita.

Main Results:

• Certificate-of-need (CON) laws demonstrated no statistically significant impact on the number of substance use treatment facilities, beds, or clients.
• CON laws did not significantly affect the acceptance of Medicare by treatment providers.
• A statistically significant 6.0% reduction in the acceptance of private insurance was observed in states with CON laws.

Conclusions:

• Current evidence suggests substance use Certificate-of-need (CON) laws do not enhance treatment access.
• CON laws appear to negatively impact private insurance utilization in substance use disorder treatment.
• Policymakers should re-evaluate the effectiveness of substance use CON laws in achieving their intended public health goals.