The local agencies charged with reviewing applications for new health care delivery proposals could be eliminated during the upcoming legislative session.

Health planning agencies are fighting to stay alive after Gov. Tim Kaine's proposal to centralize the certificate of public need application process in Richmond. Those involved with the five regional agencies, which includes the Health Planning Agency of Southwest Virginia, argue that if the governor's proposal is enacted, the local community voice could be lost in the process.

"It's really the only means by which local people have an input over the health offerings in their community," said Steve Smeltzer, one of the board members for the Health Planning Agency of Southwest Virginia. "How could somebody in Richmond make decisions about us over here? ... I don't think it is to anyone's advantage to consolidate it into Richmond."

Marilyn Tavenner, Virginia's secretary of health and human resources, said the change would still allow for local input. "What we would do is we would notify local government and local entities that a COPN was filed and work with local government to set up a public hearing to make sure the community had input," Tavenner said. "The process would not change."

The issue is more of a financial decision than a way to alter the regulatory process, Tavenner said. Kaine outlined the change as part of his budget proposal.

"If the budget language stays in the process, our involvement will be done," said Kevin Meyer, executive director of the Health Planning Agency of Southwest Virginia.

Currently, the state contracts with the regional agencies to review the applications, hold a public hearing and make a recommendation to the state health commissioner. However, for the past two years, the agencies have received little government funding, causing the bank accounts for some of the regional agencies to dwindle.

After offering a recommendation last week to approve a Lewis-Gale Medical Center project and deny a Carilion Clinic project, the board for the Health Planning Agency of Southwest Virginia had to decide if it could afford to loan $20,500 to its counterpart representing eastern Virginia.

The board opted to not make the loan, but said it would revisit the decision in a few months if it became apparent that the Eastern Virginia Health Systems Agency would have to shut down, Smeltzer said.

With the budget shortfalls facing Virginia, Tavenner said the government cannot afford to pay the regional agencies.

"Without funding, some of them may or may not be able to handle the responsibilities of the local input process," she said.

That's where Smeltzer and others representing the regional agencies disagree.

Meyer said the money available for the certificate of public need process is not being distributed fairly. "They are trying to force the regional agencies out of the process by starving us to death," he said.

Meyer and other representatives of the five regional agencies argue that the money problem is twofold. First, they say, the total amount collected in application fees has decreased by 41 percent since 2004. Second, too much money is staying in the central offices in Richmond.

A handout compiled and distributed by the regional agencies indicates that funding to the central office has increased an average of 26 percent a year.

Representatives of the five regional agencies argue that the fees paid by certificate of public need applicants should be adjusted to address the shortfall. They also say the law should be changed to ensure that money flows from the central office to the agencies.

As it stands, any money not used by the central office is distributed among the regional agencies. If no money is left, no money is distributed.

The regional agencies have proposed raising the maximum fee amount from $20,000 to $50,000 and mandating by law that the fees are split, with half going to the central office and the rest to the agencies.