Certificate of Need (CON) State Laws

12/20/2021

Certificate of Need (CON) laws are state regulatory mechanisms for approving major capital expenditures and projects for certain health care facilities. In a state with a CON program, a state health planning agency or other entity must review and approve projects like establishing a new health care facility or expanding a facility’s health service capacity in a specified area. CON programs primarily aim to control health care costs by restricting duplicative services and determining whether new capital expenditures meet a community need.

Interactive Map of State CON Laws

Currently, 35 states and Washington, D.C., operate a CON program with wide variation state to state. The following interactive 50-state map lists the health care facilities and proposed activities covered under the CON law for each state as of December 2021. It also includes enacted CON legislation for the past three legislative sessions (2019, 2020 and 2021) as well as whether a state has a moratorium on certain health care facilities or activities.

Certificate of Need State Laws

DC PR MP GU AS VI AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Legend

 

CON program in place

 

Variation on CON program* (click on map for details)

 

No CON program 

 

No data

Click on a state to see detailed information about its certificate of need program.

 

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Alabama

Health Care Facility Licensing/Certification Agency Alabama Health Planning and Development Agency

Certificate of Need Law 

Ala. Code § 22-21-260

Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • General hospitals
  • Specialized hospitals
    • Tuberculosis
    • Psychiatric
    • Long-term-care
    • Related facilities associated with a hospital
      • Laboratories
      • Outpatient clinics
      • Central service facilities
  • Skilled nursing facilities
  • Intermediate care facilities
  • Skilled or intermediate care units operated in veteran’s nursing homes and veteran’s homes
  • Rehabilitation centers
  • Public health centers
  • Facilities for surgical treatment not requiring hospitalization
  • Kidney disease treatment centers
    • Freestanding hemodialysis units
  • Community mental health centers
  • Alcohol and drug abuse facilities
  • Facilities for the developmentally disabled
  • Hospice service providers
  • Home health agencies
  • Health Maintenance Organizations
Activities Regulated Under Certificate of Need Law
  • Constructing, developing, acquiring or establishing a new health care facility or HMO
  • Selling, leasing or another type of transfer or change in control if the transaction involves implementing one or more institutional health service
  • Capital expenditures greater than:
    • $2,000,000 for major medical equipment
    • $800,000 for new annual operating costs
    • $4,000,000 for any other capital expenditures
  • Changing bed capacity
  • Offering new health services
  • Replacing or relocating an existing acute care hospital with a new digital hospital under certain circumstances.

Other Requirements

Moratorium

No

Additional Comments

N/A

Alaska

Health Care Facility Licensing/Certification Agency Alaska Department of Health and Social Services / Division of Health Care Services

Certificate of Need Law 

Alaska Stat. § 18-07-31 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Private, municipal, state or federals hospitals
  • Psychiatric hospitals
  • Independent diagnostic testing facilities
  • Residential psychiatric treatment centers
  • Tuberculosis hospitals
  • Skilled nursing facilities
  • Kidney disease treatment centers, including free-standing hemodialysis units
  • Intermediate care facilities
  • Ambulatory surgical facilities
Activities Regulated Under Certificate of Need Law
  • Capital expenditures greater than $1 million that include:
    • Constructing a new health care facility
    • Altering the bed capacity of a health care facility
    • Adding a new category of health services provided at the facility
  • Converting a building or part of a building to a nursing home requiring state licensure

 

Other Requirements

Moratorium

No
Additional Comments N/A

Arizona

Health Care Facility Licensing/Certification Agency Arizona Department of Health Services / Emergency Medical Services & Trauma System

Certificate of Need Law 

No*
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments *Although Arizona does not operate an official CON program, the state requires an application for ambulance services and ambulances to be filed with the Department of Health Services, Bureau of Emergency Medical Services & Trauma System (Ariz. Rev. Stat. Ann. § 36-2232).

Arkansas

Health Care Facility Licensing/Certification Agency Arkansas Health Services Permit Agency

Certificate of Need Law 

Ark. Stat. Ann. § 20-8-101 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Nursing home facilities
  • Residential care facilities
  • Assisted living facilities
  • Post-acute head injury retraining facilities
  • Residential care facilities
  • Other long-term medical care or personal care facilities
  • Home health care services agencies
Activities Regulated Under Certificate of Need Law
  • Constructing a nursing home
  • Adding new long-term care beds or expanding existing long-term care bed capacity
  • Adding or expanding home health services
  • Creating hospice programs
  • Moving long-term care beds from one site to another
  • Moving a site location for an approved project
  • Transferring a permit of approval, legal title or right of ownership

Other Requirements

Moratorium

  • Constructing a new residential care facility
  • Replacing a residential care facility with 16 beds or more
  • Adding new beds or expanding existing bed capacity for residential care facilities
Additional Comments N/A

California

Health Care Facility Licensing/Certification Agency California Office of Statewide Health Planning and Development

Certificate of Need Law 

No
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments N/A

Colorado

Health Care Facility Licensing/Certification Agency Colorado Department of Public Health & Environment / Health Facilities and Emergency Medical Services Division

Certificate of Need Law 

No
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments N/A

Connecticut

Health Care Facility Licensing/Certification Agency Connecticut State Office of Health Strategy

Certificate of Need Law 

Conn. Gen. Stat. § 19a-630 (General health facilities) | Conn Gen. Stat. 17b-352 (Long-term care facilities)
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws

General Health Facilities:

  • Hospitals
  • Specialty hospitals
  • Free-standing emergency departments
  • Outpatient surgical facilities
  • Hospitals or other facilities or institutions operated by the state that provides services that are eligible for reimbursement under Medicare and Medicaid
  • Central service facilities
  • Mental health facilities
  • Substance abuse treatment facilities
  • Parent companies, subsidiaries, affiliates or joint ventures of such facilities

Long-Term Care Facilities:

  • Residential facilities for persons with intellectual disabilities
  • Nursing homes
  • Rest homes
  • Residential care homes
Activities Regulated Under Certificate of Need Law

General Health Facilities:

  • Establishing a new health care facility
  • Transferring the ownership of a health care facility
  • Transferring ownership of a large group practice to another entity other than a physician or physician group
  • Establishing a free-standing emergency department
  • Terminating hospital inpatient/outpatient services
  • Establishing an outpatient surgical facility or a short-term acute care general hospital
  • Terminating surgical services in an outpatient facility
  • Terminating an emergency department by a short-term acute general hospital
  • Establishing cardiac services, including inpatient and outpatient cardiac catheterization, interventional cardiology and cardiovascular surgery
  • Acquiring CT, MRI, PET or PET/CT scanners
  • Acquiring non-hospital based linear accelerators
  • Increasing the licensed bed capacity of a health care facility
  • Acquiring equipment using technology currently not being used in the state
  • Increasing by two or more operating rooms within any three-year period for an outpatient surgical facility or short-erm acute care general hospital
  • Terminating inpatient or outpatient services offered by a hospital or other facility that provides services that are eligible for Medicare or Medicaid reimbursement

Long-Term Care Facilities:

  • Transferring ownership
  • Introducing new functions or services
  • Terminating services
  • Decreasing total bed capacity
  • Relocating a facility’s licensed beds
  • Capital expenditures exceeding a certain statutory limit

Other Requirements

Moratorium

No
Additional Comments N/A

Delaware

Health Care Facility Licensing/Certification Agency Delaware Department of Health and Social Services / Health Care Commission, Health Resources Board

Certificate of Need Law 

Del. Code Ann. tit. 16 § 9301 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Nursing homes
  • Free-standing birthing centers
  • Free-standing surgical centers
  • Free-standing acute inpatient rehabilitation hospitals
  • Free-standing emergency centers
  • Continual care community and other non-traditional, long-term care facilities
Activities Regulated Under Certificate of Need Law
  • Constructing, developing or establishing a health care facility
  • Acquiring a nonprofit health care facility
  • Capital expenditures greater than $5.8 million or another amount adjusted for inflation
  • Changing the bed capacity of a health care facility by 10 or more beds
  • Acquiring major medical equipment

Other Requirements

Moratorium

N/A
Additional Comments N/A

Florida

Health Care Facility Licensing/Certification Agency Florida Agency for Health Care Administration

Certificate of Need Law 

Fla. Stat. § 408.031 et seq.
Recent Legislative Activity HB 21 (Enacted 2019) eliminates CON review for general hospitals, complex medical rehabilitations beds, tertiary hospitals and specialty hospitals. The legislation maintains CON review for long-term care facilities.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Skilled nursing facilities
  • Hospices
  • Intermediate care facilities for the developmentally disabled
Activities Regulated Under Certificate of Need Law
  • Adding beds to community nursing homes or intermediate care facilities for the developmentally disabled
  • Constructing or establishing additional health care facilities
  • Converting from one type of health facility another
  • Establishing a hospice or hospice inpatient facility

Other Requirements

Moratorium

N/A
Additional Comments N/A

Georgia

Health Care Facility Licensing/Certification Agency Georgia Department of Community Health / Office of Health Planning

Certificate of Need Law 

Ga. Code § 31-6-40 et seq.
Recent Legislative Activity

HB 186 (Enacted 2019) modifies various components of the CON review process, including:

  • Increasing the financial threshold for health care projects requiring CON review from $2.5 million to $10 million
  • Limiting entities that can oppose a CON application to those within a 35-mile radius of the project
  • Exempting rural hospitals from the fee schedule for CON applications
  • Prohibiting hospitals from purchasing, renewing or extending a lease for the “medical use rights” of properties (e.g., a property owner agreeing not to sell or lease their property for certain medical uses or purposes).

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Destination cancer hospitals
  • Other special care units, including podiatric facilities
  • Skilled nursing facilities
  • Intermediate care facilities
  • Personal care homes
  • Ambulatory surgical facilities
  • Obstetrical facilities
  • Free-standing emergency department or facilities not located on a hospital’s primary campus
  • Health maintenance organizations
  • Home health agencies
  • Diagnostic, treatment and rehabilitation centers
Activities Regulated Under Certificate of Need Law
  • Constructing, developing or establishing a new, expanded or relocated health care facility
  • Capital expenditures more than $10 million
  • Purchasing or leasing diagnostic or therapeutic treatment
  • Increasing bed capacity
  • Offering new clinical health services
  • Converting or upgrading any general acute care hospital to a specialty hospital
  • Converting a facility not covered by CON to a facility covered by CON
  • Offering new radiation therapy, biliary lithotripsy, surgical and cardia catheterization services in a diagnostic, treatment or rehab center setting

Other Requirements

Moratorium

N/A
Additional Comments N/A

Hawaii

Health Care Facility Licensing/Certification Agency Hawaii Department of Health / State Health Planning & Development Agency

Certificate of Need Law 

Hawaii Rev. Stat. § 323D-42 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Surgical centers
  • Extended care and rehabilitation centers
  • Nursing homes
  • Skilled nursing facilities
  • Intermediate care facilities
  • Hospices
  • Kidney disease treatment centers, including free-standing hemodialysis units
  • Outpatient clinics
  • Ambulatory health care facilities
  • Emergency care facilities and centers
  • Home health agencies
  • Health maintenance organizations
Activities Regulated Under Certificate of Need Law
  • Constructing, expanding, altering, converting, developing, initiating or modifying a health care facility or health care services that exceeds the capital expenditure minimum
  • Substantially modifying or increasing the scope or type of health services rendered
  • Increasing, decreasing or changing the class of usage of beds in a facility
  • Relocating beds from one physical facility to another

Other Requirements

Moratorium

No
Additional Comments N/A

Idaho

Health Care Facility Licensing/Certification Agency Idaho Department of Health and Welfare

Certificate of Need Law 

No
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments N/A

Illinois

Health Care Facility Licensing/Certification Agency Illinois Health Facilities & Services Review Board

Certificate of Need Law 

Ill. Rev. Stat. ch. 20, § 3960/1 et. seq.
Recent Legislative Activity SB 1739 (Enacted 2019) requires CON approval for closing a health care facility.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Long-term care facilities
  • Dialysis centers
  • Ambulatory surgery centers
  • Alternative health care delivery models
  • Free-standing emergency centers
  • Birthing centers
Activities Regulated Under Certificate of Need Law
  • Constructing or modifying by or on behalf of a health care facility that exceeds the capital expenditure minimum
  • Acquiring and housing major medical equipment
  • Adding a new category of services
  • Substantially increasing a facility’s bed capacity
  • Substantially changing the scope of function of a health care facility

Other Requirements

Moratorium

No
Additional Comments Illinois’ CON law is scheduled to be repealed December 2029.

Indiana

Health Care Facility Licensing/Certification Agency Indiana Department of Health / Consumer Services and Health Care Regulation

Certificate of Need Law 

Ind. Code § 16-29-7 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws Comprehensive care facilities (nursing homes)
Activities Regulated Under Certificate of Need Law
  • Building, developing or establishing a new health care facility
  • Moving an existing health care facility to another county
  • Relocating beds from one facility to another
  • Changing the comprehensive bed capacity of a health care facility
  • Changing the type or scope of any health care serviced offered by a health care facility

Other Requirements

Moratorium

No
Additional Comments After having initially repealed their CON program, Indiana re-established a CON program in 2018 pursuant to SB 190.

Iowa

Health Care Facility Licensing/Certification Agency Iowa Department of Public Health / State Health Facilities Council

Certificate of Need Law 

Iowa Code § 135.61 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Health care facilities
    • Residential care facilities
    • Nursing facilities
    • Intermediate care facilities for persons with mental illness
    • Intermediate care facilities for person with an intellectual disability
  • Organized outpatient health facilities
  • Outpatient surgical facilities
  • Community mental health facilities
  • Birthing centers
Activities Regulated Under Certificate of Need Law
  • Offering or developing a new or changed institutional health care service, including:
  • Constructing, developing or establishing a new institutional health facility
  • Relocating an institutional health facility
  • Capital expenditures, leases or donations by or on behalf of an institutional health facility for more than $1.5 million within a 12-month period
  • Permanently changing the bed capacity of an institutional health facility
  • Expenditures of more than $500,000 for new services
  • Deleting one or more health service previously offered on a regular basis—or relocating one or more service from one health facility to another
  • Acquiring replacement equipment valued at $1.5 million or more, including for on behalf of a physician or physician group.
  • Adding air transportation services*
  • Mobile health services value at $1.5 million or more, including
    • Cardiac catheterization services
    • Open heart surgical services
    • Organ transplantation services
    • Certain radiation therapy services

Other Requirements

Moratorium

No
Additional Comments *While Iowa’s CON statute includes review and approval for adding air ambulance services, the Iowa Department of Justice found that federal aviation law preempts this state requirement and that the Iowa Department of Public Health should not enforce this requirement.

Kansas

Health Care Facility Licensing/Certification Agency Kansas Department of Health and Environment / Health Facilities Program

Certificate of Need Law 

No
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments N/A

Kentucky

Health Care Facility Licensing/Certification Agency Kentucky Cabinet for Health and Family Services / Division of Certificate of Need

Certificate of Need Law 

Ky. Rev. Stat. § 216B.010 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Psychiatric hospitals
  • Physical rehabilitation hospitals
  • Chemical dependency programs
  • Nursing facilities
  • Nursing homes
  • Personal care homes
  • Intermediate care facilities
  • Family care homes
  • Outpatient clinics
  • Ambulatory care facilities
  • Ambulatory surgical centers
  • Emergency care centers and services
  • Ambulance providers
  • Hospices
  • Community mental health centers
  • Home health agencies
  • Kidney disease treatment centers and hemodialysis units
Activities Regulated Under Certificate of Need Law
  • Establishing a health facility
  • Obligating a capital expenditure which exceed the capital expenditure minimum
  • Making a substantial change in the bed capacity of a health facility
  • Making a substantial change in a health service
  • Making a substantial change in a project
  • Acquiring major medical equipment
  • Altering a geographical area or altering a specific location which has been designated on a certificate of need or license
  • Transferring an approved certificate of need for establishing a new health facility/replacing a licensed facility.

Other Requirements

Moratorium

No
Additional Comments N/A

Louisiana

Health Care Facility Licensing/Certification Agency Louisiana Department of Health

Certificate of Need Law 

La. Rev. Stat. Ann. § 2116*
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Nursing facilities
  • Skilled nursing facility
  • Intermediate care facilities for person with developmental disabilities
  • Adult residential care providers or facilities
  • Home- and community-based service providers
  • Adult day health care providers
  • Hospice providers or inpatient hospice facilities
  • Pediatric day health care facilities
  • Behavioral health services providers
Activities Regulated Under Certificate of Need Law
  • Licensing additional units, providers or facilities
  • Changing providers participating in the Medicaid program

Other Requirements

Moratorium

  • Intermediate care facilities for the developmentally disabled
  • Long-term care hospitals and beds
  • Nursing facilities (until July 1, 2022)
Additional Comments *The Louisiana Department of Health notes it operates a Facility Need Review (FNR) process rather than a Certificate of Need program. However, most researchers identify Louisiana as a CON state, because its FNR process operates similar to that of a CON program.

Maine

Health Care Facility Licensing/Certification Agency Maine Department of Health and Human Services / Division of Licensing and Certification

Certificate of Need Law 

Me. Rev. Stat. Ann. tit. 22, § 326 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Psychiatric hospitals
  • Nursing facilities
  • Kidney disease treatment centers, including free-standing hemodialysis facilities
  • Rehabilitation facilities
  • Ambulatory surgical facilities
    • Operating rooms
    • Recovery rooms
    • Waiting areas for ambulatory surgical facility patients
    • Any space with major medical equipment
    • Any space used primarily to support activities of the ambulatory surgical facility
  • Independent radiological service centers
  • Independent cardiac catheterization centers
  • Cancer treatment centers
Activities Regulated Under Certificate of Need Law
  • Transferring ownership or acquiring another health care facility by lease, donation or transfer
  • Acquiring major medical equipment
  • Capital expenditures of $10 million or more
  • Establishing a new health service
  • Establish a new health care facility
  • Increasing the existing licensed bed complement or the licensed bed category by more than 10%

Other Requirements

Moratorium

No
Additional Comments N/A

Maryland

Health Care Facility Licensing/Certification Agency Maryland Department of Health / The Maryland Health Care Commission

Certificate of Need Law 

Md. Health Code Ann. § 19-120 et seq. | COMAR 10.24.01 et seq. 
Recent Legislative Activity

SB 940 (Enacted 2019) modifies various components of the CON review process, including:

  • Modifying requirements relating to CON approval for changes in health care service capacity.
  • Repealing the capital expenditure thresholds for non-hospital facilities.
  • Repealing a provision authorizing a hospital to acquire a free-standing ambulatory surgical facility or a health care practitioner’s office/group practice under certain circumstances.
  • Exempting ambulatory surgical centers with one or two operating rooms from CON review.
  • Deeming an uncontested CON application as approved if the Maryland Health Care Commission does not act within 120 days of the application being submitted.

HB 626 (Enacted 2019) exempts certain intermediate care and hospice facilities from CON review for increasing or decreasing their bed capacity.

SB 597 (Enacted 2019) modifies the capital expenditure threshold for hospitals from $10 million to a defined “hospital capital threshold” (i.e., the lesser of 25% of the hospital’s gross regulated charges for the preceding year or $50 million).

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Limited-service hospitals
  • Related institutions providing domiciliary, personal or nursing care
  • Ambulatory surgical facilities
  • Rehabilitation facilities
  • Home health agencies
  • Hospices
  • Other institutions, services or programs that may be specified to require a Certificate of Need
Activities Regulated Under Certificate of Need Law
  • Building, developing establishing a new health care facility
  • Moving an existing health care facility to another site
  • Changing the bed capacity of a health care facility
  • Changing the type or scope of any health service offered by a health care facility
  • Making a health care facility expenditure exceeding a threshold established in Maryland statute

Other Requirements

Moratorium

No
Additional Comments N/A

Massachusetts

Health Care Facility Licensing/Certification Agency Massachusetts Department of Public Health

Certificate of Need Law 

Mass. Gen. Laws Ann. ch. 111 §25C et seq.*
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals or clinics
  • Long-term care facilities
  • Clinical laboratories
  • Public medical institutions, including for the developmentally disabled or mentally ill
  • Any other facilities licensed by the state which requires a Determination of Need
Activities Regulated Under Certificate of Need Law
  • Substantial capital expenditures for constructing or substantially changing health services
  • Acquiring medical equipment for more than $250,000
  • Acquiring an existing health care facility

Other Requirements

Moratorium

No**
Additional Comments

*Massachusetts uses the term Determination of Need (DoN) rather than Certificate of Need.

**Massachusetts previously maintained a moratorium on increasing the number of long-term care beds, but the state started accepting DoN applications for expanding LTC beds under certain circumstances in response to COVID-19.

Michigan

Health Care Facility Licensing/Certification Agency Michigan Department of Health and Human Services

Certificate of Need Law 

Mich. Comp. Laws § 333.22201 et seq.
Recent Legislative Activity

SB 440 (Enacted 2021) authorizes the Michigan Department of Health and Human Services to approve pilot projects for providing positron emission topography (PET) scanning services without having to obtain CON approval, if DHHS determines the projects meets certain criteria.

SB 1160 (Enacted 2020) amends CON requirements for extended services programs.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Psychiatric hospitals or psychiatric units licensed under the mental health code
  • Nursing homes or hospital long-term care units
  • Free-standing surgical outpatient facilities
  • Health maintenance organizations
Activities Regulated Under Certificate of Need Law
  • Acquiring an existing health facility or beginning to operate a health facility at a site that is not currently licensed for that type of facility
  • Changing the bed capacity of a health facility
  • Initiating, replacing or expanding a covered clinical service
  • Extending care services programs (e.g., swing beds)
  • Making a covered capital expenditure that exceeds the capital expenditure threshold

Other Requirements

Moratorium

No
Additional Comments N/A

Minnesota

Health Care Facility Licensing/Certification Agency Minnesota Department of Health

Certificate of Need Law 

No*
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

Additional Comments *Minnesota does not operate a CON program. However, the state maintains moratoriums and processes for exceptions to moratorium for several health facilities.

Mississippi

Health Care Facility Licensing/Certification Agency Mississippi Department of Health / Office of Health Policy and Planning

Certificate of Need Law 

Miss. Code Ann. § 41-7-171 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Psychiatric hospitals
  • Chemical dependency hospitals
  • Skilled nursing facilities
  • End-stage renal disease facilities, including free-standing hemodialysis units
  • Intermediate care facilities
  • Ambulatory surgical facilities
  • Intermediate care facilities for the mentally retarded
  • Home health agencies
  • Psychiatric residential treatment facilities
  • Pediatric skilled nursing facilities
  • Long-term care hospitals
  • Comprehensive medical rehabilitation facilities, including facilities owned or operated by the state or a political subdivision
Activities Regulated Under Certificate of Need Law
  • Constructing, developing or establishing a new health care facility
  • Relocating a health facility
  • Relocating major medical equipment to a site more than a mile away
  • Changing bed complement
  • Offering covered services not offered in previous 12 months
  • Relocating health services from one facility to another that is more than a mile away
  • Acquiring major medical equipment
  • Changing ownership of existing health care facilities

Other Requirements

Moratorium

  • Skilled nursing facilities
  • Intermediate care facilities
  • Converting hospitals beds to skilled or intermediate nursing home care
  • Medicaid-certified child/adolescent psychiatric or chemical dependency beds
  • Intermediate care facilities for the mentally retarded
Additional Comments N/A

Missouri

Health Care Facility Licensing/Certification Agency Missouri Department of Health and Senior Services / Missouri Health Facilities Review Committee

Certificate of Need Law 

Mo. Rev. Stat. § 197.300 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Residential care facilities
  • Assisted living facilities
  • Intermediate care facilities
  • Skilled nursing facilities
  • Long-term care beds in a hospital
  • Long-term care hospitals
Activities Regulated Under Certificate of Need Law
  • Developing a new health care facility
  • Acquiring, including by lease, any health care facility or major medical equipment
  • Capital expenditures by or on behalf of a health care facility
  • Predevelopment activities costing more than $150,000
  • Changing the licensed bed capacity of a health care facility by more than 10 beds or more than 10% of that total capacity, whichever is less, over a two-year period
  • Offering a new health service (excluding home health services) that was not offered in the last twelve months at a health care facility
  • Relocating licensed beds among major types of services or reallocating licensed beds from one facility to another by more than 10 beds or more than 10% of the total licensed bed capacity, whichever is less

Other Requirements

Moratorium

No
Additional Comments N/A

Montana

Health Care Facility Licensing/Certification Agency Montana Department of Public Health and Human Services / Quality Assurance Division, Licensure Bureau

Certificate of Need Law 

Mont. Code Ann. § 50-5-301 et seq.
Recent Legislative Activity HB 231 (Enacted 2021) revises the CON review process to only include oversight of long-term care facilities and swing beds.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Long-term care facilities
Activities Regulated Under Certificate of Need Law
  • Capital expenditures over $1.5 million
  • Changing bed capacity of a capacity of a facility through an increase in number, or relocation, of beds.
  • Adding health services associated with annual operating expenses of $150,000 or more
  • Constructing, developing or establishing a facility
  • Establishing a home health agency or expanding to another service area
  • Using more than five hospital beds to provide skilled nursing care (i.e., swing bed).

Other Requirements

Moratorium

No
Additional Comments N/A

Nebraska

Health Care Facility Licensing/Certification Agency Department of Health and Human Services / Division of Public Health, Licensure Unit

Certificate of Need Law 

Neb. Rev. Stat. § 71-5829 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Skilled nursing facilities
  • Intermediate care facilities
  • Nursing facilities
  • Long-term care hospitals
  • Rehabilitation beds in inpatient facilities
Activities Regulated Under Certificate of Need Law
  • Establishing long-term care beds or rehabilitation beds
  • Increasing the long-term beds of a health facility by more than 10 or more than 10% of total beds in the facility
  • Increasing the rehabilitation beds of a health facility by more than 10 or more than 10% of total beds in the facility
  • Establishing long-term beds through conversion by a hospital
  • Establishing rehabilitation beds through conversion by a hospital
  • Relocating rehabilitation beds from one health care facility to another

Other Requirements

Moratorium

  • Long-term care beds
  • Rehabilitation beds
Additional Comments N/A

Nevada

Health Care Facility Licensing/Certification Agency Nevada Division of Public and Behavioral Health / Health Planning and Primary Care

Certificate of Need Law 

Nev. Rev. Stat. § 439A-010 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Health facilities broadly defined as a facility in or through which health service are provided
Activities Regulated Under Certificate of Need Law
  • Capital expenditures above $2 million for constructing a new health care facility in rural counties. Construction is defined to include increasing the square footage to an existing health care facility or redesigning/renovating an existing building currently not used by a health facility. 

Other Requirements

Moratorium

No
Additional Comments N/A

New Hampshire

Health Care Facility Licensing/Certification Agency

New Hampshire Department of Health and Human Services / Health Facilities Administration

Certificate of Need Law 

No*
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments

*New Hampshire repealed its certificate of need program in 2016 pursuant to SB 481 and switched to a specialized licensure process for certain health facility projects, including establishing cardiac catherization, open heart surgery and megavoltage radiation therapy services.

New Jersey

Health Care Facility Licensing/Certification Agency

New Jersey Department of Health / Health Facilities

Certificate of Need Law 

N.J. Rev. Stat. §26-2H-5.8 et seq.
Recent Legislative Activity Previous law established a CON exemption for nursing homes that propose to increase their total number of licensed beds by less than 10 beds or less than 10% of its licensed bed capacity, whichever is less, within a five-year period.  AB 4477 (Enacted 2020) prohibits a nursing home from transferring or selling a licensed bed obtained through CON exemption. It also prohibits a nursing home to seek this CON exemption if it has removed beds from its license within the last five years.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • General hospitals
  • Special hospitals
  • Mental hospitals
  • Public health centers
  • Diagnostic centers
  • Treatment centers
  • Rehabilitation centers
  • Extended care facilities
  • Skilled nursing homes
  • Intermediate care facilities
  • Assisted living residences
  • Comprehensive personal care facilities
  • Tuberculosis hospitals
  • Chronic disease hospitals
  • Maternity hospitals
  • Outpatient clinics
  • Dispensaries
  • Home health care agencies
  • Residential health care facilities
  • Bioanalytical laboratories
  • Central services facilities
Activities Regulated Under Certificate of Need Law
  • Initiating new health care services
  • Modifying, replacing or expanding any health care service or facility
  • Establishing a new health care facility
  • Reopening closed beds, facilities or services that require CON
  • Closing a general hospital
  • Transferring ownership of a general hospital or transfers that will result in a new Medicare provider number for the hospital involved
  • Increasing the number of licensed beds or changing in bed complement
  • Adding cardiac catheterization equipment
  • Purchasing major medical equipment exceeding $2 million
  • Capital expenditures exceeding $2 million

Other Requirements

Moratorium

No
Additional Comments N/A

New Mexico

Health Care Facility Licensing/Certification Agency

New Mexico Department of Health / Office of Facilities Management

Certificate of Need Law 

No
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments N/A

New York

Health Care Facility Licensing/Certification Agency

New York State Department of Health

Certificate of Need Law 

N.Y. Public Health Law § 2802 et seq.
Recent Legislative Activity SB 1451A (Enacted 2021) requires most applications for CON approval to include a health equity impact assessment of the proposed project. 

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Nursing homes
  • Diagnostic and treatment centers
  • Ambulatory surgery centers
  • Certified home health agencies
  • Long term home health care programs
  • Hospices
  • Adult care facilities (process is different for ACFs compared to other facilities)
  • Adult day health care programs
  • Certain programs associated with the Office of Mental Health, Office of Mental Retardation and Developmental Disabilities and the Office of Alcoholism and Substance Abuse Services
Activities Regulated Under Certificate of Need Law
  • Establishing or constructing new facilities, agencies, programs or hospices
  • Renovating existing facilities, agencies, programs or hospices
  • Acquiring major medical equipment
  • Adding or deleting health care services
  • Changing ownership of facilities, agencies, programs or hospices
  • Modifying service areas for agencies or hospices

Other Requirements

Moratorium

No
Additional Comments N/A

North Carolina

Health Care Facility Licensing/Certification Agency

North Carolina Department of Health and Human Services / Division of Health Service Regulation

Certificate of Need Law 

N.C. Gen. Stat. § 131E-175 et seq.
Recent Legislative Activity SB 462 (Enacted 2021) increases the dollar threshold triggering CON review for new diagnostic center equipment, major medical equipment and capital expenditures for new institutional health services. It also requires projects with CON approval to initiate construction within a specified timeframe.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Long-term care hospitals
  • Psychiatric facilities
  • Rehabilitation facilities
  • Nursing home facilities
  • Adult care homes
  • Kidney disease treatment centers, including free-standing hemodialysis units
  • Intermediate care facilities for individuals with intellectual disabilities
  • Home health agency offices
  • Chemical dependency treatment facilities
  • Diagnostic centers
  • Hospice offices
  • Hospice inpatient facilities
  • Hospice residential care facilities
  • Ambulatory surgical facilities
Activities Regulated Under Certificate of Need Law
  • Offering new institutional health services, including developing a new a health service facility
  • Adding beds, operating rooms, gastrointestinal endoscopy rooms or dialysis stations
  • Initiating new cardiac catheterization services, open-heart surgery services, burn intensive care service, neonatal intensive care services or solid organ or bone marrow transplantation services
  • Acquiring major medical equipment
  • Relocating health service facility beds, operating rooms GI endoscopy rooms or dialysis stations from one facility to another

Other Requirements

Moratorium

No
Additional Comments N/A

North Dakota

Health Care Facility Licensing/Certification Agency North Dakota Health Department / Division of Health Facilities

Certificate of Need Law 

No
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments N/A

Ohio

Health Care Facility Licensing/Certification Agency Ohio Department of Health

Certificate of Need Law 

Ohio Rev. Code Ann. § 3701-12-01 et seq.
Recent Legislative Activity

HB 166 (Enacted 2019) modifies various components of the CON review process, including:

  • Requiring the department of health to determine whether a CON application is complete within 180 days.
  • Revising the department of health’s timeline for conducting a long-term care bed need determination assessment.
  • Revising the department of health’s comparative review timeline.
  • Establishing a moratorium on CON review through July 2021 unless specific circumstances are met.
  • Limiting the ability for CON decision appeals to only the CON applicant.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Long-term care facilities
Activities Regulated Under Certificate of Need Law
  • Establishing, developing or constructing a new long-term care facility
  • Replacing an existing long-term care facility
  • Renovating or adding to a long-term care facility involving a capital expenditure of $4 million or more
  • Increasing long-term care bed capacity
  • Relocating long-term care beds from one site to another
  • Any site or capacity change within five years of implementation if not in accordance with the approved CON
  • Expenditures over 110% of the maximum expenditure specified in an approved CON application

Other Requirements

Moratorium

Long term care beds
Additional Comments N/A

Oklahoma

Health Care Facility Licensing/Certification Agency

Oklahoma State Department of Health

Certificate of Need Law 

Okla. Stat. tit. 63 § 1-850 et seq. | Okla. Stat. tit. 63 § 1-880.5
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Long-term care facilities
  • Specialized facilities for developmentally disabled clients
  • Hospital-based skilled nursing units
  • Psychiatric or chemical dependency facilities
Activities Regulated Under Certificate of Need Law
  • Long-term care facilities
    • Establishing a new facility
    • Increasing the number of beds at an existing facility
    • Acquiring ownership or operation of a facility
    • Capital expenditures greater than $1,000,000 or more
  • Psychiatric or chemical dependency facilities
    • Developing a facility or offering services
    • Capital investments of $500,000 or more

Other Requirements

Moratorium

No
Additional Comments N/A

Oregon

Health Care Facility Licensing/Certification Agency

Oregon Health Authority / Public Health Division

Certificate of Need Law 

Or. Rev. Stat. § 442-015 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Skilled nursing facilities
  • Intermediate care facilities
  • Long-term care facilities
  • Health facility established by a health maintenance organization
Activities Regulated Under Certificate of Need Law
  • Developing a new hospital or service
  • Developing a new long-term care facility or service
  • Increasing the number of skilled nursing, intermediate care or long-term care facility beds by more than 10 or by 10% of the facility’s capacity, whichever is less
  • Rebuilding or relocating an existing long-term care facility

Other Requirements

Moratorium

No
Additional Comments N/A

Pennsylvania

Health Care Facility Licensing/Certification Agency

Pennsylvania Department of Health

Certificate of Need Law 

No
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments N/A

Rhode Island

Health Care Facility Licensing/Certification Agency State of Rhode Island Department of Health / Center for Health Systems Policy and Regulation

Certificate of Need Law 

R.I. Gen. Laws § 23-15-2 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
  • Nursing facilities
  • Home nursing-care providers
  • Home care providers
  • Hospice providers
  • Inpatient rehabilitation centers, including drug and/or alcohol abuse treatment centers
  • Free-standing emergency care facilities
  • Facilities providing surgical treatment to patients not requiring hospitalization
  • Facilities providing inpatient hospice care
Activities Regulated Under Certificate of Need Law
  • Developing or establishing a new health care facility above a specified capital expenditure threshold
  • Offering services with a new piece of health care equipment above a specified capital expenditure threshold
  • Acquisitions that increase the bed capacity, redistribute beds among services, or adds or terminates new health services
  • Increasing the total number of beds in a health care facility above a specified capital expenditure threshold
  • Offering new health services that increasing operating costs above a certain amount

Other Requirements

Moratorium

New nursing facilities, nursing facility licensed beds, and increases in capacity of licensed nursing facilities (until July 1, 2022).
Additional Comments N/A

South Carolina

Health Care Facility Licensing/Certification Agency South Carolina Department of Health and Environmental Control

Certificate of Need Law 

S.C. Code Ann. § 44-7-110 et seq.
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Acute care hospitals
  • Psychiatric hospitals
  • Alcohol and substance abuse hospitals
  • Nursing homes
  • Ambulatory surgical facilities
  • Hospice facilities
  • Radiation therapy facilities
  • Rehabilitation facilities
  • Residential treatment facilities for children and adolescents
  • Intermediate care facilities for person with intellectual disabilities
  • Narcotic treatment programs
  • Any other facility for which a CON is required by federal law
Activities Regulated Under Certificate of Need Law
  • Constructing or establishing a new health care facility
  • Changing existing bed capacity
  • Capital expenditures greater than $5 million
  • Offering new health care services
  • Acquiring medical equipment that costs more than $1.5 million

Other Requirements

Moratorium

No
Additional Comments N/A

South Dakota

Health Care Facility Licensing/Certification Agency South Dakota Department of Health / Office of Health Facilities Licensure and Certification

Certificate of Need Law 

No
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments N/A

Tennessee

Health Care Facility Licensing/Certification Agency

Tennessee Department of Health / Division of Health Planning

Certificate of Need Law 

Tenn. Code Ann. § 68-11-1602 et seq.
Recent Legislative Activity

HB 948 (Enacted 2021) enacts several changes to the state’s CON program, including:

  • Increasing fees for implementing/enforcing the CON program on certain facilities (e.g., hospital, nursing homes, ambulatory surgical treatment centers and others).
  • Exempting certain facilities (e.g., mental health hospitals) from CON review.
  • Exempting certain activities (e.g., any activity in an economically distressed county without a hospital) from CON review.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Nursing homes
  • Recuperations centers
  • Hospitals
  • Ambulatory surgical treatment centers
  • Mental health hospitals
  • Intellectual disability institutional habilitation facilities
  • Home care organizations
  • Outpatient diagnostic centers
  • Rehabilitation facilities
  • Residential hospices
  • Nonresidential substitution-based treatment center for opiate addiction
Activities Regulated Under Certificate of Need Law
  • Constructing, developing or establishing a health care facility
  • Changing the licensed bed complement of a facility
  • Initiating the following services:
    • Burn unit
    • Nenatal intensive care unit
    • Open heart surgery
    • Organ transplantatin
    • Cardiac catheterizatin
    • Linear acceleratr
    • Psitron emission tomography
    • Hme health
    • Hspice
    • Psychiatric
    • Opiate addictin treatment provided through a non-residential substitution-based treatment center for opiate addiction.
  • Initiating MRI or PET scan services in certain locations

Other Requirements

Moratorium

No
Additional Comments N/A

Texas

Health Care Facility Licensing/Certification Agency Texas Health and Human Services

Certificate of Need Law 

No
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments N/A

Utah

Health Care Facility Licensing/Certification Agency Utah Department of Health / Bureau of Health Facility Licensing, Certification and Resident Assessment

Certificate of Need Law 

No
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments N/A

Vermont

Health Care Facility Licensing/Certification Agency

State of Vermont Green Mountain Care Board

Certificate of Need Law 

Vt. Stat. Ann. tit. 18 V.S.A., § 9432 et seq.
Recent Legislative Activity

HB 742 (Enacted March 2020) allows the Green Mountain Care Board to waive CON requirements in response to COVID-19.

SB 14 (Enacted 2019) extends until January 2025 the existing moratorium for new home health agencies and offering of home health services.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospitals
    • General hspitals
    • Mental hspitals
    • Chrnic disease facilities
    • Birthing centers
    • Maternity hspitals
    • Psychiatric facilities
  • Nursing Homes
  • Health maintenance organizations
  • Home health agencies
  • Outpatient diagnostic or therapy programs
  • Kidney disease treatment centers
  • Mental health agencies or centers
  • Diagnostic imaging facilities
  • Independent diagnostic laboratories
  • Cardiac catheterizations laboratories
  • Radiation therapy facilities
  • Ambulatory, surgical, diagnostic or treatment centers
Activities Regulated Under Certificate of Need Law
  • Constructing, developing, purchasing, renovating or establishing a health care facility or other capital expenditure exceeding a certain amount (amount differs if the facility is a hospital or non-hospital facility)
  • Establishing ambulatory surgical centers
  • Changing the licensed bed capacity
  • Offering any home health services
  • Purchasing, leasing or other comparable arrangement of a single piece of diagnostic and therapeutic equipment greater than $1 million
  • Offering a health care service or technology with an annual operating expense greater than $500,000
  • Constructing, developing, purchasing, leasing or establishing an ambulatory surgical center

Other Requirements

Moratorium

No CON can be granted for the offering of home health services, which includes hospices or new home health agencies, through Jan. 1, 2025, or until the General Assembly lifts the moratorium.
Additional Comments N/A

Virginia

Health Care Facility Licensing/Certification Agency

Virginia Department of Health / Office of Licensure and Certification, Division of Certificate of Public Need

Certificate of Need Law 

Va. Code §32.1-102.1 et seq.
Recent Legislative Activity

SB 279 (Enacted 2020) requires the state health commissioner to consider the impact of proposed projects on all individuals, not just residents in a service area, when evaluating a medical facility project for Certificate of Public Need (COPN) approval.

HB 1870 (Enacted 2019) provides for a 30-day exemption from the requirement to obtain a COPN for increasing the total number of beds in existing hospitals or nursing homes if the state health commissioner determines that a natural or human-made disaster has caused the evacuation of a hospital or nursing home and that a public health emergency exists due to a shortage of hospital or nursing home beds.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • General hospitals
  • Sanitariums
  • Nursing homes
  • Intermediate care facilities with exceptions
  • Extended care facilities
  • Mental hospitals
  • Facilities for individuals with developmental disabilities
  • Psychiatric hospitals and intermediate care facilities for individuals with substance abuse
  • Specialized centers, clinics or physicians’ office developed for the provision of:
    • Ambulatry surgery
    • Cardiac catheterizatins
    • Cmputed tomographic (CT) scanning
    • Steretactic radiosurgery
    • Lithtripsy
    • Magnetic resnance imaging (MRI)
    • Magnetic surce imaging (MSI)
    • Psitron emission tomographic (PET) scanning
    • Radiatin therapy
    • Steretactic radiotherapy
    • Prton beam therapy
    • Nuclear medicine imaging
    • Other specialty services
  • Rehabilitation hospitals
  • Hospitals
Activities Regulated Under Certificate of Need Law
  • Establishing a medical care facility
  • Increasing the total number of beds or operating rooms
  • Relocating beds from an existing facility to another
  • Introducing new nursing home services
  • Introducing new medical equipment
  • Converting beds to rehabilitation or psychiatric beds
  • Capital expenditures of $15 million or more by a non-hospital facility and $5 million or more by a hospital

Other Requirements

Moratorium

None, but COPNs for an increase in nursing beds are subject to the department issuing a request for applications for an increase in beds.
Additional Comments N/A

Washington

Health Care Facility Licensing/Certification Agency

Washington State Department of Health

Certificate of Need Law 

Wash. Rev. Code §70-38-025 et seq.
Recent Legislative Activity

SB 5236 (Enacted 2021) extends the CON exemption for new psychiatric hospitals and increasing the number of psychiatric hospital beds to June 2023.
 

SB 6359 (Enacted 2020) exempts rural health clinics providing services in home health shortage areas from CON review.


HB 1394 (Enacted 2019) exempts psychiatric beds from CON review through June 2021.


HB 1777 (Enacted 2019) exempts ambulatory surgical facilities from CON review if the facility meets the following requirements:

  1. The facility is an individual or group practice (and, if it is a group practice, the facility is not extended to physicians outside the group practice).
  2. The facility operated or received approval to operate prior to Jan. 19, 2018.
  3. The facility was exempt from CON requirements prior to Jan. 19, 2018.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Hospices
  • Hospice care centers
  • Hospitals
  • Psychiatric hospitals
  • Nursing homes
  • Kidney disease treatment centers
  • Ambulatory surgical facilities
  • Home health agencies
Activities Regulated Under Certificate of Need Law
  • Constructing, developing or establishing certain health facilities
  • Increasing the number of stations at a kidney dialysis center
  • Selling, purchasing or leasing all or part of an existing hospital
  • Increasing the number licensed beds at a hospital, nursing home or hospice care center
  • Offering new tertiary health services including:
    • Level 1 rehabilitatin programs
    • Open heart surgery
    • Therapeutic cardiac catheterizatins
    • Organ transplantatin specialty burn services
    • Intermediate care nursery and/r obstetric services
    • Level II nenatal intensive care nursey and/or obstetric services
    • Level III specialized inpatient pediatric services
  • Nursing home capital expenditures greater than $2.83 million
  • Nursing home bed banking transactions
  • Nursing home replacements

Other Requirements

Moratorium

No
Additional Comments N/A

West Virginia

Health Care Facility Licensing/Certification Agency West Virginia Health Care Authority

Certificate of Need Law 

W. Va. Code §16-2D-2 et seq.
Recent Legislative Activity

HB 4108 (Enacted 2020) establishes exemptions from CON review for certain facilities and projects, including:

  • Private practices acquiring CT scanners for up to $750,000.
  • Nonprofit primary care centers (with a community board and providing services without regard to ability pay) establishing a birthing center.
  • Health care facilities acquiring major medical equipment, adding health services and pursuing capital expenditures for research, if certain conditions are met.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Public or private facility, agency or entity that offers or provides health services, whether a for-profit or nonprofit entity and whether licensed, or required to be licensed, in whole or in part.
Activities Regulated Under Certificate of Need Law
  • Adding or expanding health care services
  • Activities exceeding a certain capital expenditures threshold
  • Obtaining major medical equipment valued above a certain amount
  • Developing or acquiring new health care facilities

Other Requirements

Moratorium

  • New intermediate care or skilled nursing beds
  • New skilled nursing facilities
  • New intermediate care beds for persons with intellectual disabilities.
  • Opioid treatment programs.
  • In-home personal care services
Additional Comments N/A

Wisconsin

Health Care Facility Licensing/Certification Agency Wisconsin Department of Health Services

Certificate of Need Law 

No*
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

  • Nursing homes are subject to a statewide bed limit.
  • Hospital beds
Additional Comments * Wisconsin does not have an official certificate of need program. The state, however, maintains certain approval processes for long-term care; moratoriums for hospital, psychiatric and chemical dependency, and nursing home beds; and a certificate of public advantage program pursuant to Wis. Stat. § 150.

Wyoming

Health Care Facility Licensing/Certification Agency

Wyoming Department of Health / Healthcare Licensing and Surveys

Certificate of Need Law 

No
Recent Legislative Activity N/A

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws N/A
Activities Regulated Under Certificate of Need Law N/A

Other Requirements

Moratorium

No
Additional Comments N/A

Washington D.C.

Health Care Facility Licensing/Certification Agency District of Columbia Health

Certificate of Need Law 

D.C. Code Ann. § 44-401 et seq.
Recent Legislative Activity B 307 (Enacted 2021) allows a CON that expired during or 30 days before the declared COVID-19 public health emergency to remain effective until 60 days after the end of the public health emergency.

Facilities and Activities Overview

Facilities Regulated Under Certificate of Need Laws
  • Private general hospitals
  • Psychiatric hospitals
  • Other specialty hospitals
  • Rehabilitation facilities
  • Skilled nursing facilities
  • Intermediate care facilities
  • Ambulatory care centers or clinics
  • Ambulatory surgical facilities
  • Kidney disease treatment centers
  • Free-standing hemodialysis facilities
  • Diagnostic health care facilities
  • Home health agencies
  • Hospices
  • Other comparable health care facilities with an annual operating budget of at least $500,000
Activities Regulated Under Certificate of Need Law
  • Constructing, developing or otherwise establishing a new health care facility, health care services or home health agency
  • Making capital expenditures of $6 million or more in connection with a hospital and $3.5 million in connection with a health service or health facility
  • Making a capital expenditure $3.5 million or more by a hospital, or $2 million by a health care facility to acquire major medical equipment
  • Acquiring by lease, purchase, donation or other comparable arrangement a single piece of diagnostic or therapeutic equipment by or on behalf of a physician, physician group or independent owner/operator. Applies to acquisitions above $350,000.
  • Relocating beds from one facility to another
  • Redistributing the beds of a health care facility by 10 beds or 10%, whichever is less, in any two-year period
  • Offering any health service, which was not offered on a regular basis by the health care facility within the previous 12-month period.
  • Increasing the number of renal dialysis stations on a facility—or moving stations from one facility to another
  • Acquiring an existing health care facility or major medical equipment by purchase, lease or other arrangement

Other Requirements

Moratorium

N/A
Additional Comments N/A

U.S. Virgin Islands

No Data

Puerto Rico

No Data
 

State Actions Summary

In the past several years, many states have introduced or enacted legislation to modify their CON programs. Changes range from fully repealing an existing CON program to creating a new CON program. However, most state legislation makes targeted changes to CON oversight, such as excluding specific facilities from CON review.   

  • Currently, 35 states and D.C. maintain some form of CON program. States with CON laws most often regulate hospitals, outpatient facilities and long-term care facilities.
  • As of 2021, 12 states have fully repealed their CON programs or allowed the program to expire. New Hampshire was the most recent state to repeal its CON program in 2016.
  • Three states—Arizona, Minnesota and Wisconsin—do not officially operate a CON program, but they maintain several approval processes that function similarly to CON. 
  • In 2020, at least six states—Michigan, New Jersey, Vermont, Virginia, Washington, and West Virginia—enacted legislation to modify their CON laws in some capacity. Additionally, at least six states—Michigan, Montana, New YorkNorth Carolina, Tennessee and Washington—and Washington, D.C. enacted CON legislation in 2021. Montana’s legislation was the most sweeping of these bills, exempting all facilities except long-term care facilities from CON review.  
  • Related to CON, at least 13 states have a moratorium on certain health care activities and capital expenditures, meaning they will not grant CON or state approval for a specific activity. Moratoria are most common for long-term care related activities, such as expanding the number of long-term care beds in a facility.

Intent and Structure of CON

A primary objective of state CON laws is to control health care costs by avoiding unnecessary expansion or duplicative services within an area. Proponents of CON laws contend that if excess health care service capacity exists, price inflation may occur to compensate for new, underused health care services or empty beds. Some states also require CON approval for health facility mergers, acquisitions or changes in ownership, which many researchers say contributes to higher health care costs and prices.

Beyond cost containment efforts, CON laws aim to ensure access to services for historically underserved communities, such as rural areas, and meet the health care needs of indigent patients. For example, some states require health facilities to establish financial assistance policies and provide discounted care to low-income patients as a condition for CON approval.

While proponents of CON argue the state laws achieve these aims, many opponents argue CON laws have the opposite effect on health care costs and access to quality health services. Opponents believe CON laws stifle competition by protecting incumbent providers and creating a burdensome approval process for establishing new facilities and services. Additionally, many maintain there is little to no evidence that CON laws deliver on controlling health care costs, improving quality or ensuring access to health care services for patients.  

The structure of CON review and approval varies state to state, but generally a health care facility must seek state approval—through a state health planning agency, department of health or a CON council appointed by the governor or legislature—based on a set of criteria and community need. These state entities often look at criteria such as:

  • The projected need for the health care service within the area.
  • Whether a facility has the staff capacity or financing for a proposed activity.
  • The effects of a proposed project on specific populations (e.g., rural communities).
  • The effects of a proposed project on health care costs.  

Once a health facility has applied for state approval, the state may approve, deny or set certain limitations on a health care project. 

History

New York was the first state to enact a CON law in 1964; 26 states enacted CON laws throughout the following decade. Early CON programs typically regulated capital expenditures greater than $100,000, facilities expanding bed capacity and facilities establishing or expanding health care services.

In 1972, several states adopted Section 1122 waivers, which provided federal funding to states regulating new health care services receiving Medicare and Medicaid dollars. Congress then passed the National Health Planning and Resources Development Act of 1974 bolstering federal funding for state and local health planning regulations.

The federal law required states to adopt CON laws similar to the federal model resulting in all states, except Louisiana, with some form of a CON program by 1982. This meant states had broad regulatory oversight over several facilities—including hospitals, nursing and intermediate care facilities, and ambulatory surgery centers—as well as the expansion or development of a facility’s service capacity. 

The federal mandate was repealed in 1987, along with the associated federal funding. Subsequently, several states repealed or modified their CON laws.

Additional Resources