In the last round of arguments before a final decision on a new hospital in Montgomery County, Holy Cross Hospital is calling for Maryland state regulators to adopt an earlier state recommendation favoring Holy Cross over rival Adventist HealthCare.

Last week, Adventist challenged that recommendation, asking the Maryland Health Care Commission to delay a final decision at its Jan. 20 meeting and reopen a review because of what Adventist said were flawed and unsupported conclusions about cost and other key factors.

On Thursday, Holy Cross responded by calling Adventist's challenges "mostly a restatement of arguments previously made and appropriately rejected" in the state's earlier recommendation. In a 66-page filing with the state commission, Holy Cross characterized its rival's 104 pages of arguments as "having more heft than substance."

For two years, the two health-care giants have been battling for state approval to build a hospital in Montgomery's fastest-growing region. Holy Cross wants to build one on the campus of Montgomery College in Germantown; Adventist's proposal is for one in Clarksburg.

It was an important victory for Holy Cross when Marilyn Moon, who chairs the commission and conducted the review, sided with Holy Cross in findings rendered Dec. 17. She cited the Silver Spring-based provider's track record in quality of care and other factors, and she also noted that its parent organization, Trinity Health, a Catholic hospital system, was financially well positioned.

Last week, Rockville-based Adventist HealthCare said one of the flaws in Moon's recommendation involves reproductive services that would not be offered by Holy Cross.

Several women's groups and reproductive health advocates have raised concerns about religious directives that prevent Catholic hospitals from providing a variety of services, including fertility treatments, abortions, tubal ligations and hormonal contraception. Because of those restrictions, the groups say, the Holy Cross proposal would undermine public health priorities.

Moon concluded that Montgomery County was not an area "that lacks available and accessible options for obtaining these services."

Adventist said no testimony was presented on the issue, and Moon provided no evidence to support her conclusion.

In its response Thursday, Holy Cross said a Web search shows "many locations for family planning services in upper Montgomery County." It also said that services not provided by Holy Cross are already available at the four existing non-Catholic hospitals in the county. Holy Cross will provide emergency contraception at its proposed Germantown hospital, the filing said.