A new twist in the Certificate of Needs approval process needed by health care systems and other medical providers to build new facilities gives competitors a second chance to state their case.

How the extended appeals option plays out in this area’s highly competitive healthcare landscape remains to be seen.

The law – passed in July by the N.C. General Assembly – blocks the start of construction of a new hospital or other healthcare facility until the CON appeals process runs its course. Previously, an appeal could be filed by a rival but construction could go forward, as was the case with Novant Health’s Presbyterian Hospital in Huntersville, which was built despite a CON appeal filed by Lake Norman Regional Medical Center.

“Before the law was passed, once the CON office issued a certificate of need, you could begin building. We did that with our hospital in Huntersville,” said Jim Tobalski, a senior vice president with Novant Health.

Tobalski said that after Novant Health filed a certificate of need with the state Department of Health and Human Services several years ago to build a replacement facility for Brunswick Community Hospital, New Hanover Regional Medical Center filed its own comments “questioning the need for the hospital,” but did not file a competitive CON.

And when Novant Health filed a CON for a surgery center with two operating rooms on Eastwood Road in Wilmington, New Hanover Regional Medical Center and two private physician groups also filed CONs with the state, Tobalski said. The Novant Health facility is under construction after the matter was resolved through arbitration.

Now armed with the ability to follow an appeals process through to the end, rival health care systems could conceivably delay construction plans of competitors in the hope the state may reconsider.

“The law is still too new to affect (current) construction projects. The future outcome is it could delay projects longer from start to finish,” Tobalski said.

New Hanover Regional Medical Center spokeswoman Carolyn Fisher said the law has not impacted recent and ongoing projects like the construction of a women’s and children’s hospital and renovation of the patient tower on the hospital’s main campus.

Both New Hanover Regional and Novant Health are aggressively expanding the reach of their respective healthcare systems into the other’s territories, which include New Hanover and Brunswick counties.

“The changes have had no affect on us to date and we have not had any delays as a result of this change,” Fisher said.

The N.C. Certificate of Need law prohibits health care providers from acquiring, replacing or adding to their facilities and their equipment, except in specified circumstances, without DHHS prior approval.

According to the state agency, the fundamental premise of the CON law is controlling increasing health care costs by governmental restrictions “on the unnecessary duplication of medical facilities.”

Those include all new hospitals, psychiatric facilities, chemical dependency treatment facilities, nursing homes, adult care homes, hospices, diagnostic centers and ambulatory surgical facilities.

To date, “There have been no delays in the CON review and decision process as a result of the change in the law,” DHHS spokesman Lee Hoffman said.

“I cannot speak to the motivation of appellants,” said Hoffman, adding that the right to appeal CON decisions existed before the new law was passed.

“The legislation was sponsored by the CON (section) itself,” Tobalski said. “They were looking for a way to make the process as detailed as possible. They will not issue a CON in the future until all the entities’ appeals process has been exhausted and gone through.”

There will always be projects “which health care providers wish didn’t exist,” Tobalski said, just as there are projects no one will oppose. In highly competitive areas like Charlotte, virtually all CON applications are appealed, he said.

“It’s really related to competitive CONs. Not all CONs are competitive,” Tobalski said. “It could happen in the New Hanover region.”