Tennessee lawmakers are taking a swing at one of the state’s biggest health care gatekeeping tools, moving to pull acute-care hospitals out of the certificate-of-need system that has long controlled who can build where. House Bill 819, sponsored by Rep. Johnny Garrett (R-Goodlettsville), cleared a key committee this week and is headed to a subcommittee hearing, with supporters promising shorter wait times and critics warning of a power grab by large hospital systems.
What the bill would do
As introduced, HB0819 would exempt acute-care hospitals from the requirement to obtain a certificate of need starting July 1, 2028, according to the Tennessee General Assembly. The measure defines an acute-care hospital by average length of stay and identifies a Senate companion bill, SB1369.
Why backers say it will help
Supporters say rolling back the rules will unlock new clinics, drive more competition and cut the time patients spend waiting to see specialists. They point to growing delays in basic access to doctors: a national survey from AMN Healthcare found average new-patient physician appointment wait times rose about 19% since 2022 and 48% since 2004, with the typical wait now roughly 31 days across 15 metro areas and several specialties.
Local hospitals and lawmakers weigh in
Rep. William Lamberth (R-Portland) told FOX17 that “doing away with certificate of need … will drop wait times at hospitals” and create more places for patients to seek care. Democrats, including Sen. Raumesh Akbari, counter that the change is tailored to benefit certain hospital systems and “is a complicated issue,” raising concerns about consolidation as health networks spread across Middle Tennessee.
TriStar, for example, has floated a major expansion with a new facility in Spring Hill as part of its regional growth plans. According to Hoodline, a $250 million hospital proposal for Spring Hill was reported last year.
What critics warn and existing rules
Opponents note Tennessee has already eased some certificate-of-need rules, including a 2025 carve-out for freestanding emergency departments, and argue that a full exemption for acute-care hospitals could leave rural communities vulnerable if market shake-outs follow. The Tennessee Health Facilities Commission currently maintains a public list of existing exemptions and explains how providers file an initial notification under Public Chapter 985, and HFC rules still govern licensure and distance calculations. The Tennessee Health Facilities Commission and a fiscal memo from the Tennessee General Assembly lay out the practical steps and estimated fee impacts tied to those changes…