Homebound patients across South Carolina may be forced to find new health care companies to meet their medical needs now that a complex, decades old regulation is up-and-running after nearly a yearlong hiatus.

The controversial Certificate of Need program, which Gov. Nikki Haley tried to scrap and the state health department director wants to overhaul, threatens to push some new providers out of business - particularly in a few of the state's poorest, rural counties.

National Healthcare Corporation, which operates several home health care agencies in South Carolina, must apply for a Certificate of Need to continue serving patients in Abbeville, McCormick, Newberry and Saluda counties, the state health department informed the company on June 30. It doesn't likely qualify for one.

Catherine Templeton, director of the S.C. Department of Health and Environmental Control, acknowledged that the company's position is unfortunate, especially because many of "our state's most vulnerable citizens" rely on their home-based services, but said there's nothing she can do.

After a temporary suspension, the General Assembly recently restored funding for the Certificate of Need program, but it did not reform it the way Templeton believes is necessary.

"Unfortunately, the CON reform bill did not pass this session, and the current law ties our hands completely," she said.

National Healthcare Corporation filed a civil action this week in the fifth judicial circuit in Richland County against DHEC.

The Certificate of Need program regulates the number of hospitals, nursing homes and home health care agencies - among other health care services - allowed to operate throughout the state. It is intended to avoid duplication and control costs, but Haley and others have argued that it stifles competition. The Certificate of Need program was temporarily suspended last summer when she vetoed funding for it, throwing the industry into a state of confusion.

"We should allow the market to work rather than politics," she wrote at the time.

After Haley's veto, DHEC issued dozens of licenses for home health care agencies throughout South Carolina without requiring them to apply for a Certificate of Need.

Roper St. Francis Home Health Care, for example, expanded its services from three counties to 10 counties in December. National Healthcare Corporation expanded its reach into several new markets.

Several hospital projects were approved, too. Trident Medical Center, for example, was granted permission to add 14 rehabilitation beds in North Charleston. Typically, the hospital would have needed a Certificate of Need to proceed with that project, but Templeton said she had no authority to enforce the CON program without any money for it.

The South Carolina Supreme Court disagreed. In April, the court ruled in favor of the South Carolina Hospital Association, determining that DHEC must administer the program even though there was no funding.

Several recently-approved licenses are now in jeopardy.

A administrative law judge ruled in June that Trident Medical Center must forfeit those new rehabilitation beds. Templeton said DHEC can't renew licenses for these home health agencies, either.

To be relicensed, they need a certificate, Templeton said. "They can operate until their license expires. When their license expires, it's out of our hands. . The best we can do is not go shut them down right now - and we're not."

The home health care agencies are unlikely to qualify for a Certificate of Need even if they tried to apply for one, she said, because the state has reached capacity for these providers under the agency's current rules.

In court documents, National Healthcare Corporation argues it will suffer "immediate and irreparable harm" if DHEC denies its ability to operate in Abbeville, McCormick, Newberry and Saluda.

A hearing has been set for July 10. A lawyer for the company did not respond to a message left Thursday.

Rick Sellers, chairman of the South Carolina Healthcare Association Board of Directors and administrator for the National Healthcare Corporation nursing home in Greenwood, said confusion reigns.

"Nobody really knows at this point what the outcome of this will be," he said.

Reach Lauren Sausser at 937-5598.