alabama - national conference of state legislatures · 2019-11-19 · national conference of state...

NATIONAL CONFERENCE OF STATE LEGISLATURES

Alabama

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

Has certificate of need law? Yes

Dates of certificate of need program: 1979 - present

Facilities regulated under certificate of need law:

• General hospital

• Specialized hospital

o Tuberculosis

o Psychiatric

o Long term care

o Related facilities

▪ 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

o 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

Capital expenditures regulated under certificate of need law:

• Constructing, developing, acquiring or establishing a new

health care facility or HMO

• Capital expenditures greater than:

o $2,000,000 for major medical equipment

o $800,000 for new annual operating costs

o $4,000,000 for any other capital expenditures

• Changing bed capacity

• Offering new health services

http://www.shpda.state.al.us/

http://www.shpda.state.al.us/

http://www.shpda.state.al.us/documents/conforms/Rules%20Effective%205.5.2017%20Searchable%207.16.2019.pdf#page=12

http://www.shpda.state.al.us/documents/conforms/Rules%20Effective%205.5.2017%20Searchable%207.16.2019.pdf#page=31


Alaska

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

Care Services


Dates of certificate of need program: 1979 – present


• Acute care hospital

• Ambulatory surgical center

• Critical access hospital

• Independent diagnostic testing facility

• Intermediate care facility

• Intermediate care facility for the mentally retarded

• Kidney dialysis center

• Nursing facility

• Psychiatric hospital

• Residential psychiatric treatment center


• Constructing a health care facility



• Converting a building or part of a building to a nursing home

requiring licensure.

http://dhss.alaska.gov/dhcs/Pages/CertificateOfNeed/default.aspx

http://dhss.alaska.gov/dhcs/Pages/CertificateOfNeed/default.aspx

http://www.akleg.gov/basis/aac.asp#7.07.900

http://www.akleg.gov/basis/aac.asp#7.07.900


Arizona

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

Trauma System

Has certificate of need law? No*

Dates of certificate of need program: 1983 - present; 1971-1985


• Ambulatory services


• Operating an ambulance

*Although Arizona does not operate an official certificate of need program, an application for ambulance services and ambulances must be filed

with the Department of Health Services, Bureau of Emergency Medical Services & Trauma System.

https://www.azdhs.gov/preparedness/emergency-medical-services-trauma-system/index.php#ambulance-ground-program-con

https://www.azdhs.gov/preparedness/emergency-medical-services-trauma-system/index.php#ambulance-ground-program-con

https://azdhs.gov/documents/director/administrative-counsel-rules/rules/guidance/gd-099-phs-ems.pdf

https://www.azleg.gov/ars/36/02212.htm


Arkansas

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




• Assisted living services

• Home health care services

• Hospice services

• Nursing facilities


• Constructing a nursing home


• Adding or expanding home health services

• Adding or expanding hospice services

• Increasing costs of an approved project

• Moving existing long-term care beds

• Moving the site location of a permit of approval

• Transferring a permit of approval, legal title or ownership

https://ahspa.arkansas.gov/

https://ahspa.arkansas.gov/Websites/ahspa/files/Content/6410812/Permit_of_Approval_Rulebook__.pdf#page=2

https://ahspa.arkansas.gov/Websites/ahspa/files/Content/6410812/Permit_of_Approval_Rulebook__.pdf#page=9


California

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

Has certificate of need law? No

Dates of certificate of need program: 1969-1987

Facilities regulated under certificate of need law: N/A

Capital expenditures regulated under certificate of need law: N/A

https://oshpd.ca.gov/


Colorado

Health Care Facility Licensing/Certification Agency: Colorado Department of Public Health & Environment / Health Facilities

and Emergency Medical Services Division





https://www.colorado.gov/pacific/cdphe/health-facilities-and-emergency-medical-services-division-topics





Connecticut

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


Dates of certificate of need program: 1973 – present


• Hospitals licensed by the Department of Public Health

• Specialty hospitals

• Freestanding 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

• Any parent company, subsidiary, affiliate or joint venture, or

any combination thereof, of any such facility.

• Intermediate care facilities for persons with intellectual

disabilities

• Nursing homes

• Rest homes

• Residential care homes


• Establishing a new health care facility

• Transferring ownership of a health care facility

• Transferring ownership of a large group practices

• Establishing a freestanding emergency department

• Terminating inpatient or outpatient services

• Establishing an outpatient surgical facility

• Terminating surgical services by an outpatient surgical

facility

• Terminating an emergency department by a short-term

acute general hospital

• Establishing cardiac services

• Acquiring major medical equipment

• Acquiring nonhospital based linear accelerators

• Increasing licensed bed capacity

• Acquiring equipment utilizing technology that has not

previously been utilized in the state

• Increasing two or more operating rooms within a three-year

period

• Terminating inpatient or outpatient services offered by a

hospital, facility or institution operated by the state

https://portal.ct.gov/OHS


https://www.cga.ct.gov/current/pub/chap_368z.htm#sec_19a-630

https://www.cga.ct.gov/current/pub/chap_368z.htm#sec_19a-638


Delaware

Health Care Facility Licensing/Certification Agency: Delaware Department of Health and Social Services / Health Care

Commission, Health Resources Board

Has certificate of need law? Yes*

Dates of certificate of need program: 1978-present


• Acute care facilities

o Short-term medical services

o Surgical services

• Obstetric care facilities

o Labor

o Delivery

o Recovery

• Nursing home facilities

• Freestanding surgery center

o Ambulatory surgery

• Acquisition of major medical equipment by health care

facilities, as well as non-health care facilities


• Constructing, developing or establishing a new health care

facility

• Acquiring a nonprofit health care facility

• Capital expenditures greater than $5,800,000

• Changing the bed capacity of a health care facility by more

than 10 beds or 10% of existing beds


*Delaware uses the term certificate of public review.

https://www.dhss.delaware.gov/dhss/dhcc/hrb/dhrbhome.html

https://www.dhss.delaware.gov/dhss/dhcc/hrb/dhrbhome.html

http://www.dhss.delaware.gov/dhss/dhcc/hrb/dhrbhome.html

http://www.dhss.delaware.gov/dhss/dhcc/hrb/dhrbhome.html

https://www.dhss.delaware.gov/dhss/dhcc/hrb/files/hrmpupdseptember2017.pdf

https://www.dhss.delaware.gov/dhss/dhcc/hrb/files/hrmpupdseptember2017.pdf#page=7


Florida

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




• Hospices


• Intermediate care facilities for the developmentally disabled

• Class II hospitals

o Specialty hospitals for children

o Specialty hospitals for women

• Class III hospitals

o Specialty medical hospitals

o Specialty rehabilitation hospitals

o Specialty psychiatric hospitals

o Specialty substance abuse hospitals

• Class IV hospitals

o Intensive Residential Treatment Programs for

Children and Adolescents


• Adding beds in nursing homes or intermediate care facilities

for the developmentally disabled

• Constructing or establishing additional health care facilities

• Converting from one type of health care facility to another

• Increasing the total licensed bed capacity for

comprehensive rehabilitation facilities

• Establishing hospices or hospice inpatient facilities

• Establishing inpatient tertiary health services

• Increasing the number of beds for acute care in a hospital

• Increasing sheltered nursing home beds

• Transferring a certificate of need

• Replacing a nursing home

• Relocating a portion of the nursing home’s licensed bed

*Effective July 2019, general hospitals – including acute care facilities, long-term care facilities, and rural hospitals – are no longer subject to CON

approval pursuant to HB 21.

http://ahca.myflorida.com/MCHQ/CON_FA/

http://ahca.myflorida.com/MCHQ/CON_FA/

https://www.flrules.org/gateway/RuleNo.asp?title=PROCEDURES%20FOR%20THE%20ADMINISTRATION%20OF%20SECTIONS%20408.031-408.045,%20FLORIDA%20STATUTES,%20HEALTH%20FACILITY%20AND%20SERVICES%20DEVELOPMENT%20ACT&ID=59C-1.004

https://www.flrules.org/gateway/RuleNo.asp?title=PROCEDURES%20FOR%20THE%20ADMINISTRATION%20OF%20SECTIONS%20408.031-408.045,%20FLORIDA%20STATUTES,%20HEALTH%20FACILITY%20AND%20SERVICES%20DEVELOPMENT%20ACT&ID=59C-1.004

https://www.flsenate.gov/Session/Bill/2019/21


Georgia

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


Dates of certificate of need program: 1979- present


• Hospitals

• Cancer hospitals

• Special care unites

o Podiatric facilities

o Skilled nursing facilities

o Intermediate care facilities

o Personal care homes

o Ambulatory surgical or obstetrical facilities

o Health maintenance organizations

o Home health agencies

o Diagnostic, treatment, or rehabilitation centers


• Establishing new hospitals, including general, acute care and

specialty hospitals

• Establishing or expanding nursing homes and home health

agencies

• All multi-specialty and certain single-specialty ambulatory

surgery centers

• Providing radiation therapy, positron emission tomography,

open heart surgery and neonatal services

• Purchasing or leasing major medical equipment that

exceeds equipment thresholds

• Renovating major hospitals or other capital activities by any

health care facility that exceed the capital expenditure

thresholds

• Offering new health care services

https://dch.georgia.gov/certificate-need-con

http://rules.sos.ga.gov/GAC/111-2-2-.01

http://rules.sos.ga.gov/GAC/111-2-2


Hawaii

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

Agency




• Hospitals

• Extended care and rehabilitation centers

• Nursing homes



• Hospices for the terminally ill that require certification and

licensure by the department of health



• Outpatient clinics

• Organized ambulatory health care facilities

• Emergency care facilities and centers


• Health maintenance organizations

• Others providing similarly organized services regardless of

nomenclature


• Constructing, expanding, altering, converting, developing,

initiating or modifying a health care facility or health care

services exceeding the expenditure minimum

• Substantially modifying or increasing the scope or type of

health services rendered

• Change in bed capacity

• Relocating beds from one facility to another

http://health.hawaii.gov/shpda/certificate-of-need/

http://health.hawaii.gov/shpda/certificate-of-need/

https://health.hawaii.gov/shpda/files/2019/08/Chapter323D-HRS-2018.pdf

https://health.hawaii.gov/shpda/files/2019/08/Chapter323D-HRS-2018.pdf#page=10


Idaho

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





http://healthandwelfare.idaho.gov/Providers/tabid/284/Default.aspx


Illinois

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



Facilities regulated under certificate of need laws:

• Hospitals

• Longer-term care facilities

• Dialysis centers

• Ambulatory surgery centers

• Alternative health care delivery models

• Free-standing emergency centers

• Birthing centers

Capital expenditures regulated under certificate of need laws:

• Constructing or modifying by or on behalf of a health care

facility that exceeds the capital expenditure minimum for

that facility:

o $13,171,045.98 for hospitals

o $7,444,502for long-term care facilities

o $3,435,925.35 for other facilities

• Acquiring and housing of major medical equipment

• Offering a new category of service

• Substantially increasing a facility’s bed capacity

• Substantial changing the scope or function operation of a

facility

*Long term care facilities are no longer required to submit a certificate of need for the discontinuation or a change of ownership of a long-term

care facility pursuant to a 2018 amendment to the Health Facilities and Services Board Rules.

https://www2.illinois.gov/sites/hfsrb/conprogram/pages/default.aspx

https://www2.illinois.gov/sites/hfsrb/rules/Pages/Administrative-Rules.aspx

https://www2.illinois.gov/sites/hfsrb/CONProgram/Pages/default.aspx

https://www2.illinois.gov/sites/hfsrb/rules/Documents/77%20IAC%201125%20TEXT.pdf

https://www2.illinois.gov/sites/hfsrb/rules/Documents/77%20IAC%201125%20TEXT.pdf


Indiana

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

Regulation


Dates of certificate of need program: 1980-1996; 1997-1999; 2018 - present


• Comprehensive care facilities

o Nursing homes


• Adding, transferring or constructing comprehensive care

beds

• Adding or transferring comprehensive care beds certified to

participate in the state Medicaid program

• Converting to comprehensive care beds

*Indiana enacted SB 190 in 2018, a new certificate of need law. It requires the Office of Family and Social Services and the Department of Health

to establish a comprehensive certificate of need program and sets for the application requirements and exceptions.

https://www.in.gov/isdh/28280.htm

https://www.in.gov/isdh/28280.htm

https://www.in.gov/isdh/files/Certificate%20of%20Need%20Statute.pdf

https://www.in.gov/isdh/files/Emergency%20Rules.pdf

http://iga.in.gov/legislative/2018/bills/senate/190#digest-heading


Iowa

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




• Hospitals

• Residential care facilities


• Intermediate care facilities for persons with mental illness

• Intermediate care facilities for persons with an intellectual

disability

• Organized outpatient health facilities

• Outpatient surgical facilities

• Community mental health facilities

• Birth centers


• Constructing, developing or establishing a new institutional

health facility

• Relocating an institutional health facility

• Capital expenditure, lease or donation by or on behalf of an

institutional health facility greater than $1,500,000

• Permanently changing bed capacity

• Offering a new health care service with an expenditure

greater than $500,000

• Closing of a health service

• Acquiring any piece of replacement equipment greater than

$500,000

• Acquiring any new piece of medical equipment greater than

$1,500,000

• Adding air transportation services

• Adding mobile health services greater than $1,500,000

• Cardiac catheterizations services

• Open heart surgical services

• Organ transplantation services

• Radiation therapy services

https://idph.iowa.gov/policy-and-workforce-services/cert-of-need

https://www.legis.iowa.gov/docs/code/135C.1.pdf

http://idph.iowa.gov/Portals/1/userfiles/50/2017%20Iowa%20Code.pdf#page=3


Kansas

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

Program



Facilities regulated under certificate of need: N/A


http://www.kdheks.gov/bhfr/index.html

http://www.kdheks.gov/bhfr/index.html


Kentucky

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

of Need




• Hospitals

• Psychiatric hospitals

• Physical rehabilitation hospitals

• Chemical dependency programs


• Nursing homes’

• Personal care homes


• Family care homes


• Ambulatory care facilities

• Ambulatory surgical centers

• Emergency care centers and services

• Ambulance providers

• Hospices

• Community mental health centers

• Homes health agencies



• Others providing similarly organized services regardless of

nomenclature


• Establishing a health facility

• Capital expenditures greater than the adjusted capital

expenditure minimum

• Substantially changing bed capacity

• Substantially changing a health service

• Substantially changing a project


• Changing the geographical area or specific location which

has been designated on a certificate of need or license

• Transferring an approved certificated of need for the

Establishing a new health facility or replacement of a

licensed facility

https://chfs.ky.gov/agencies/os/oig/dcn/Pages/cn.aspx

https://chfs.ky.gov/agencies/os/oig/dcn/Pages/cn.aspx

https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=47998

https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=40526


Louisiana

Health Care Facility Licensing/Certification Agency: Louisiana Department of Health




• Nursing facility beds

o Skilled beds

o IC-II and IC-II beds

• Intermediate care facility for the developmentally disabled

• Home and community-based services

o Supervised independent living

o Personal care attendant services

o Respite

• Adult day health facilities

• Adult residential care units

• Behavioral health services providers



• Changing providers participating in the Medicaid program

*Pursuant to La. Rev. Stat. Ann. § 40-2116, the Louisiana Department of Health administers a facility need review (FNR) process, which is does

not consider a certificate of need requirement.

http://ldh.la.gov/index.cfm/directory/detail/717

http://legis.la.gov/Legis/Law.aspx?d=98042

http://legis.la.gov/Legis/Law.aspx?d=98042


Maine

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

and Certification




• Hospitals




o Freestanding hemodialysis facilities

• Rehabilitation facilities

• Ambulatory surgical facilities

• Independent radiological service centers

• Independent catheterization centers

• Cancer treatment centers


• Transferring ownership



• Offering a new health service


facility


• Any capital expenditures greater than $5,000,000 for

existing nursing facilities

https://www.maine.gov/dhhs/dlc/c_o_n/

https://www.maine.gov/dhhs/dlc/c_o_n/

https://www.maine.gov/dhhs/dlc/c_o_n/pdf/22-MRSA-chapter-103A.pdf

https://www.maine.gov/dhhs/dlc/c_o_n/pdf/22-MRSA-chapter-103A.pdf#page=9


Maryland

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

Commission




• Hospitals

• Limited service hospitals

• Related institutions




• Hospices

• Other health institutions, services or programs that may be

specified as requiring a CON



facility

• Relocating an existing health care facility

• Offering a new health care service including:

o New open-heart surgery, organ transplant surgery,

burn treatment or neonatal; intensive care program

o New home health agency, general hospice care

program or freestanding ambulatory surgical facility

o Expansion of ambulatory surgical capacity

o Establishing a new subunit in an existing home

health agency

o Expansion of a home health agency

o Transfer of ownership of a subunit or a facility-

based home health care service

o Closing an existing medical service

o Closing an existing health care facility

• Closing an existing medical service

• Closing an existing health care facility or conversion to non-

health-related use

https://mhcc.maryland.gov/mhcc/Pages/hcfs/hcfs_con/hcfs_con.aspx

https://mhcc.maryland.gov/mhcc/Pages/hcfs/hcfs_con/hcfs_con.aspx

http://www.dsd.state.md.us/comar/comarhtml/10/10.24.01.01.htm

http://www.dsd.state.md.us/comar/comarhtml/10/10.24.01.02.htm


Massachusetts

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




• Long-term care facilities

• Convalescent or nursing homes

• Rest homes or charitable homes for the aged

• Clinical laboratories

• Public medical institutions

• Institutions for the developmentally disabled or mentally ill

supported by public funds


• Constructing a health care facility or substantially changing

a facility’s service capacity

• Offering a new innovative service or technology

• Acquiring new medical, diagnostic or therapeutic

equipment greater than $250,000

• Acquiring an existing health care facility

*Massachusetts uses the term Determination of Need (DoN) for its health planning program instead of certificate of need.

https://www.mass.gov/determination-of-need-don

https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111/Section25B

https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111/Section25C


Michigan

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




• Hospitals

• Psychiatric hospitals or units

• Nursing homes and hospital long-term care units

• Freestanding surgical outpatient facilities

• HMOs (only for limited projects)


• Acquiring an existing health facility or beginning operation

at a health facility that is not currently licensed for that type

of health facility


• Initiating, replacing or expanding a covered clinical service

• Covered capital expenditures

https://www.michigan.gov/mdhhs/0,5885,7-339-71551_2945_5106---,00.html

http://www.legislature.mi.gov/(S(e3xvy12be2mnlx4c1kfyz2rd))/documents/mcl/pdf/mcl-368-1978-17-222.pdf

http://www.legislature.mi.gov/(S(e3xvy12be2mnlx4c1kfyz2rd))/documents/mcl/pdf/mcl-368-1978-17-222.pdf#page=3


Minnesota

Health Care Facility Licensing/Certification Agency: Minnesota Department of Health



Facilities regulated under certificate of need: N/A


*While Minnesota does not have a certificate of need program, it maintains various approval processes that function similarly to CON. The 2004

state legislature established a public interest review process for hospitals seeking exceptions to that state’s hospital bed moratorium law.

Additionally, the state created a local system needs plans for intermediate care facilities pursuant to Minn. Stat § 252.282. This program allows

counties to evaluate and regulate its service system to best support the needs of persons with developmental disabilities.

https://www.health.state.mn.us/facilities/regulation/index.html

https://www.health.state.mn.us/data/economics/moratorium/index.html

https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_057177

https://www.revisor.mn.gov/statutes/cite/252.282


Mississippi

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




• Hospitals

• Long term care hospitals


• Chemical dependency hospitals

• Comprehensive medical rehabilitation facilities



• Intermediate care facilities for the mentally retarded

• Psychiatric residential treatment facilities

• Pediatric skilled nursing facilities

• End stage renal disease facilities





• Capital expenditures exceeding the expenditure threshold


• Offering new institutional health services

• Offering new clinical health services


https://msdh.ms.gov/msdhsite/_static/30,0,84,301.html

https://msdh.ms.gov/msdhsite/_static/resources/7167.pdf#page=11

https://msdh.ms.gov/msdhsite/_static/resources/7167.pdf#page=18


Missouri

Health Care Facility Licensing/Certification Agency: Missouri Department of Health and Senior Services / Missouri Health

Facilities Review Committee




• Hospitals

• Long-term care hospital

• Residential care facilities

• Assisted living facilities




• Developing a new health care facility

• Acquiring any health care facility

• Acquiring any major medical equipment

• Capital expenditures greater than the expenditure minimum

• Predevelopment activities greater than $150,000

• Changing the licensed bed capacity by more than ten beds

or 10% of total bed capacity


• Reallocating licensed beds among major types of service by

more than ten beds or 10% of total bed capacity

https://health.mo.gov/information/boards/certificateofneed/index.php

https://health.mo.gov/information/boards/certificateofneed/index.php

https://health.mo.gov/information/boards/certificateofneed/pdf/law.pdf

https://health.mo.gov/information/boards/certificateofneed/pdf/law.pdf


Montana

Health Care Facility Licensing/Certification Agency: Montana Department of Public Health and Human Services / Quality

Assurance Division, Licensure Bureau




• Nonfederal home health agencies


• Inpatient chemical dependency facilities


• Capital expenditures greater than $1.5 million • Changing bed capacity of a health care facility through an

increase in the number of beds or a relocation of beds from

one health care facility to another

https://dphhs.mt.gov/qad/Licensure/HealthCareFacilityLicensure/CertificateofNeed

https://dphhs.mt.gov/qad/Licensure/HealthCareFacilityLicensure/CertificateofNeed

https://leg.mt.gov/bills/mca/title_0500/chapter_0050/part_0030/section_0010/0500-0050-0030-0010.html

https://leg.mt.gov/bills/mca/title_0500/chapter_0050/part_0030/section_0010/0500-0050-0030-0010.html


Nebraska

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

Licensure Unit




• Hospitals





• 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

http://dhhs.ne.gov/licensure/Pages/Hospital-Licensing.aspx

http://dhhs.ne.gov/licensure/Pages/Hospital-Licensing.aspx

http://dhhs.ne.gov/licensure/Documents/Facilities-NebraskaHealthCareCertificateOfNeedAct.pdf

http://dhhs.ne.gov/licensure/Documents/Facilities-NebraskaHealthCareCertificateOfNeedAct.pdf#page=6


Nevada

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

Primary Care




• Hospitals





• Capital expenditures exceeding $2,000,000 in counties with

a population less than 100,000 and cities with a population

less than 25,000.

• Capital expenditures for the operation of a new medical

helicopter providing services in an area located within 150

miles from an existing facility with helicopter services.

http://dpbh.nv.gov/Programs/Certificate_of_Need/Certificate_of_Need_-_Home/

http://dpbh.nv.gov/Programs/Certificate_of_Need/Certificate_of_Need_-_Home/

https://www.leg.state.nv.us/nrs/NRS-439A.html#NRS439ASec083

https://www.leg.state.nv.us/nrs/NRS-439A.html#NRS439ASec083


New Hampshire

Health Care Facility Licensing/Certification Agency: New Hampshire Department of Health and Human Services / Health

Facilities Administration





*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.

https://www.dhhs.nh.gov/oos/bhfa/index.htm

https://www.dhhs.nh.gov/oos/bhfa/index.htm

http://www.gencourt.state.nh.us/bill_status/billText.aspx?sy=2016&id=1054&txtFormat=html


New Jersey

Health Care Facility Licensing/Certification Agency: New Jersey Department of Health / Health Facilities




• General hospitals

• Special hospitals

• Mental hospitals

• Public health centers

• Diagnostic centers

• Treatment centers

• Rehabilitation centers

• Extended care facilities

• Skilled nursing homes


• Assisted living residences

• Comprehensive personal care facilities

• Tuberculosis hospitals

• Chronic disease hospitals

• Maternity hospitals


• Dispensaries

• Home health care agencies

• Residential health care facilities

• Bioanalytical laboratories

• Central services facilities


• Initiating new health care services

• Terminating or discontinuing services or facilities

• Reducing licensed bed capacity

• Transferring a health care service or facility

• Changing licensed bed or service capacity


• Adding cardiac catheterization equipment

https://www.nj.gov/health/healthfacilities/certificate-need/

https://advance.lexis.com/documentpage/?pdmfid=1000516&crid=a6f63709-2bd6-4c33-b22c-5b6460e2d7ea&nodeid=AALABNAACAAD&nodepath=%2FROOT%2FAAL%2FAALABN%2FAALABNAAC%2FAALABNAACAAD&level=4&haschildren=&populated=false&title=%C2%A7+8%3A33-1.3+Definitions&config=00JAA1YTg5OGJlYi04MTI4LTRlNjQtYTc4Yi03NTQxN2E5NmE0ZjQKAFBvZENhdGFsb2ftaXPxZTR7bRPtX1Jok9kz&pddocfullpath=%2Fshared%2Fdocument%2Fadministrative-codes%2Furn%3AcontentItem%3A5X92-YKJ1-JT99-22GY-00008-00&ecomp=h3t7kkk&prid=9b9d3435-f337-4179-b751-321b2acfcd1a

https://advance.lexis.com/container/?pdmfid=1000516&crid=ac4f6cae-8e16-4c6f-a103-11dfa9d9a894&func=LN.Advance.ContentView.getFullToc&nodeid=AALABNAAE&typeofentry=Breadcrumb&config=00JAA5OTY5MTdjZi1lMzYxLTQxNTEtOWFkNi0xMmU5ZTViODQ2M2MKAFBvZENhdGFsb2coFSYEAfv22IKqMT9DIHrf&action=publictoc&pddocfullpath=%2Fshared%2Fdocument%2Fadministrative-codes%2Furn%3AcontentItem%3A5X92-YKD1-F5KY-B1H0-00008-00&pdtocfullpath=%2Fshared%2Ftableofcontents%2Furn%3AcontentItem%3A7XT6-6F60-Y903-S559-00008-00&ecomp=9s-fkkk&prid=bf7dd79b-57c9-4788-a8d7-e121f6f8002c


New Mexico

Health Care Facility Licensing/Certification Agency: New Mexico Department of Health / Office of Facilities Management





https://nmhealth.org/about/ofm/


New York

Health Care Facility Licensing/Certification Agency: New York State Department of Health




• Hospitals

• Nursing homes

• Diagnostic and treatment centers

• Ambulatory surgery centers

• Certified home health agencies

• Long term home health care programs

• Hospices

• Adult care 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


• Establishing or constructing new facilities, agencies,

programs or hospices

• Renovating existing facilities, agencies, programs or

hospices


• Adding or deleting health care services

• Changing ownership of facilities, agencies, programs or

hospices

• Modifying service areas for agencies or hospices

https://www.health.ny.gov/facilities/cons/

https://www.health.ny.gov/facilities/cons/more_information/#types

https://www.health.ny.gov/facilities/cons/more_information/#types


North Carolina

Health Care Facility Licensing/Certification Agency: North Carolina Department of Health and Human Services / Division of

Health Service Regulation




• Hospitals

• Psychiatric facilities

• Chemical dependency treatment facilities

• Nursing home facilities

• Adult care homes


• Intermediate care facilities for the mentally retarded



• Hospices

• Diagnostic centers



• Offering new institutional health services

• 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


https://info.ncdhhs.gov/dhsr/coneed/index.html

https://info.ncdhhs.gov/dhsr/coneed/index.html

https://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_131E/Article_9.html

https://info.ncdhhs.gov/dhsr/coneed/overview.html


North Dakota

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





http://www.ndhealth.gov/HF/


Ohio

Health Care Facility Licensing/Certification Agency: Ohio Department of Health






• 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

• Increasing long-term care bed capacity

• Relocating long-terms care beds from one site to another

• Other failure to conduct a reviewable activity in substantial

accordance with the approved application for which a

Certificate of Need was granted, if the change is made

within five years after implementation, including a site or

capacity change

• Expenditures more than 110 percent of the maximum

expenditure specified in an approved Certificate of Need

application

https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/certificate-of-need/welcome-to

http://codes.ohio.gov/oac/3701-12

http://codes.ohio.gov/oac/3701-12-05v1


Oklahoma

Health Care Facility Licensing/Certification Agency: Oklahoma State Department of Health





o Nursing facilities

o Specialized facilities for developmentally disabled

clients

o Hospital-based skilled nursing units


• Psychiatric units

• Chemical dependency units in general acute hospitals



o Establishing a new facility

o Increasing the number of beds at an existing facility

o Acquiring ownership or operation of a facility

o Capital expenditures greater than $1,000,000 or more.

• Psychiatric and chemical dependency treatment facilities

o Transferring ownership or operation of a facility

https://www.ok.gov/health/Protective_Health/Health_Resources_Development_Service/Health_Facility_Systems_/index.html

https://www.ok.gov/health2/documents/HRDS-HFS-LTC%20CON%20act.pdf

https://www.ok.gov/health2/documents/HRDS-HFS-PsyChemCON%20act.pdf

https://www.ok.gov/health2/documents/HRDS-HFS-LTC%20CON%20act.pdf

https://www.ok.gov/health2/documents/HRDS-HFS-PsyChemCON%20act.pdf


Oregon

Health Care Facility Licensing/Certification Agency: Oregon Health Authority / Public Health Division




• Hospitals




• Developing a new hospital

• Developing a new long-term care facility or service

https://www.oregon.gov/oha/ph/ProviderPartnerResources/HealthcareProvidersFacilities/CertificateNeed/Pages/index.aspx

https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1375

https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1375


Pennsylvania

Health Care Facility Licensing/Certification Agency: Pennsylvania Department of Health





https://www.health.pa.gov/Pages/default.aspx


Rhode Island

Health Care Facility Licensing/Certification Agency: State of Rhode Island Department of Health / Center for Health Systems

Policy and Regulation




• Hospitals

• Nursing homes

• Outpatient hospice care facilities

• Outpatient kidney treatment centers

• Outpatient kidney dialysis facilities

• Outpatient birth centers

• Freestanding emergency care facilities

• Organized ambulatory care facilities

• Home health care providers


• Initial licensure for:

o Freestanding emergency care facilities,

o Outpatient kidney treatment centers

o Organized ambulatory care facilities

o Outpatient birth centers

• Capital expenditures for medical equipment and services

• Changing ownership, control or lease for:

o Hospitals

o Nursing homes

o Organized ambulatory care facilities

o Outpatient kidney dialysis facilities

o Outpatient hospice care facilities

o Freestanding emergency care facilities

o Home health care providers

http://health.ri.gov/programs/detail.php?pgm_id=1012

http://health.ri.gov/programs/detail.php?pgm_id=1012

http://webserver.rilin.state.ri.us/Statutes/TITLE23/23-15/23-15-2.HTM

http://webserver.rilin.state.ri.us/Statutes/TITLE23/23-15/23-15-4.HTM


South Carolina

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




• Acute care hospitals


• Alcohol and substance abuse hospitals

• Nursing homes



• Residential treatment facilities for children and adolescents

• Intermediate care for the mentally retarded

• Inpatient hospice facilities

• Radiation therapy facilities

• Other facilities requiring CON review by state law


• Constructing or establishing a new health care facility

• Changing existing bed capacity



• Acquiring diagnostic medical equipment greater than

$600,000

https://www.scdhec.gov/health-regulation/health-facility-regulations-licensing-con/certificate-need

https://live-sc-dhec.pantheonsite.io/sites/default/files/media/document/R.61-15.pdf#page=6

https://live-sc-dhec.pantheonsite.io/sites/default/files/media/document/R.61-15.pdf#page=4


South Dakota

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

Licensure and Certification





https://doh.sd.gov/providers/licensure/

https://doh.sd.gov/providers/licensure/


Tennessee

Health Care Facility Licensing/Certification Agency: Tennessee Department of Health / Division of Health Planning




• Nursing homes

• Recuperations centers

• Hospitals

• Ambulatory surgical treatment centers

• Mental health hospitals

• Intellectual disability institutional habilitation facilities

• Home care organizations

• Outpatient diagnostic centers


• Residential hospices

• Nonresidential substitution-based treatment center for

opiate addiction


• Initiating the following services:

o Burn unit

o Neonatal intensive care unit

o Open heart surgery

o Organ transplantation

o Cardiac catheterization

o Linear accelerator

o Positron emission tomography

o Home health

o Hospice

o Psychiatric

o Opiate addiction treatment provided through a

non-residential substitution-based treatment center

for opiate addiction.

• Initiating a magnetic resonance imaging (MRI) machine in:

o Counties with a population greater than $250,000

for pediatric services

o Counties with a population less than $250,000 for

any services

• Increasing the number of MRI machines

• Establishing a hospital satellite emergency department

facility


https://www.tn.gov/health/health-program-areas/health-planning/certificate-of-need.html

https://publications.tnsosfiles.com/acts/109/pub/pc1043.pdf

https://publications.tnsosfiles.com/acts/109/pub/pc1043.pdf


Texas

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





https://hhs.texas.gov/doing-business-hhs/provider-portals/health-care-facilities-regulation


Utah

Health Care Facility Licensing/Certification Agency: Utah Department of Health / Bureau of Health Facility Licensing,

Certification and Resident Assessment





http://health.utah.gov/hflcra/

http://health.utah.gov/hflcra/


Vermont

Health Care Facility Licensing/Certification Agency: State of Vermont Green Mountain Care Board




• Hospitals

o General hospitals

o Mental hospitals

o Chronic disease facilities

o Birthing centers

o Maternity hospitals

o Psychiatric facilities

• Nursing Homes



• Outpatient diagnostic or therapy programs


• Mental health agencies or centers

• Diagnostic imaging facilities

• Independent diagnostic laboratories

• Cardiac catheterizations laboratories

• Radiation therapy facilities

• Inpatient or ambulatory surgical, diagnostic or treatment

centers


• Constructing, developing, purchasing, renovating or

establishing a health care facility or other capital

expenditure exceeding $1,500,000


• Offering any home health services

• Purchasing, leasing or other comparable arrangement of a

single piece of diagnostic and therapeutic equipment

greater than $1,000,000

• 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

https://gmcboard.vermont.gov/con

https://legislature.vermont.gov/statutes/section/18/221/09432

https://legislature.vermont.gov/statutes/section/18/221/09434


Virginia

Health Care Facility Licensing/Certification Agency: Virginia Department of Health / Office of Licensure and Certification,

Division of Certificate of Public Need





• 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:

o Ambulatory surgery

o Cardiac catheterizations

o Computed tomographic (CT) scanning

o Stereotactic radiosurgery

o Lithotripsy

o Magnetic resonance imaging (MRI)

o Magnetic source imaging (MSI)

o Positron emission tomographic (PET) scanning

o Radiation therapy

o Stereotactic radiotherapy

o Proton beam therapy

o Nuclear medicine imaging

o Other specialty services

• Rehabilitation hospitals

• Hospitals


• Medical care facility projects

• Registering the replacement of existing medical equipment

• Registering certain capital expenditures between

$5,698,607 and $17,095,823

• Acquiring a medical care facility greater than $600,000

http://www.vdh.virginia.gov/licensure-and-certification/the-certificate-of-public-need-program/

http://www.vdh.virginia.gov/licensure-and-certification/the-certificate-of-public-need-program/

https://law.lis.virginia.gov/vacode/title32.1/chapter4/section32.1-102.1/

http://www.vdh.virginia.gov/content/uploads/sites/96/2016/07/COPN-regs-2011.pdf#page=14


Washington

Health Care Facility Licensing/Certification Agency: Washington State Department of Health




• Hospitals

• Nursing homes

• Kidney dialysis centers

• Medicare of Medicaid home health agencies

• Medicare of Medicaid hospice agencies


• Hospice care centers

• Kidney dialysis centers


• 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:

o Level 1 rehabilitation programs

o Open heart surgery

o Therapeutic cardiac catheterizations

o Organ transplantation specialty burn services

o Intermediate care nursery and/or obstetric services

o Level II neonatal intensive care nursey and/or

obstetric services

o Level III specialized inpatient pediatric services

• Nursing home capital expenditures greater than $2,663,342

• Nursing home bed banking transactions

• Nursing home replacements

https://www.doh.wa.gov/LicensesPermitsandCertificates/FacilitiesNewReneworUpdate/CertificateofNeed

https://app.leg.wa.gov/RCW/default.aspx?cite=70.38.025

https://app.leg.wa.gov/wac/default.aspx?cite=246-310-020


West Virginia

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




• Public or private facility, agency or entity that offer or provides health services,

whether a for-profit or non-profit entity and whether licensed, or required to be

licensed, in whole or in part.


• Acquiring, offering or developing a new health care service

• Charging or billing for a health care service

• Transferring equipment or facilities for less than fair market value

• Other capital expenditures

https://hca.wv.gov/certificateofneed/Pages/default.aspx

http://www.wvlegislature.gov/WVCODE/ChapterEntire.cfm?chap=16&art=2D&section=2

https://hca.wv.gov/certificateofneed/Documents/W_Va_CSR_65-32.pdf#page=5


Wisconsin

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


Dates of certificate of need program: Repealed 2000



*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/chemical dependency, and nursing home beds; and a certificate of public advantage program pursuant to

Wis. Stat. § 150.

https://www.dhs.wisconsin.gov/regulations/index.htm

http://docs.legis.wisconsin.gov/statutes/statutes/150


Wyoming

Health Care Facility Licensing/Certification Agency: Wyoming Department of Health / Healthcare Licensing and Surveys




https://health.wyo.gov/aging/hls/


District of Colombia

Health Care Facility Licensing/Certification Agency: District of Columbia Health






• Specialty hospitals




• Ambulatory care centers or clinics



• Freestanding hemodialysis facilities

• Diagnostic health care facilities


• Hospices

• Other comparable health care facilities with an annual

operating budget greater than $500,000



facility, health care service or home health agency

• Capital expenditures greater than $2.5 million for health

care services or facilities

• Capital expenditures greater than $1.5 million for major

medical equipment

• Leasing, purchasing, donating or other comparable

arrangement of a single piece of diagnostic or therapeutic

equipment by or on behalf of a physician or group of

physician group

• Relocating beds from one facility to another

• Redistributing beds by a health care facility by 10 beds or 10

percent


• Increasing renal dialysis stations

• Acquiring an existing health care facility or major medical

equipment by purchase, lease or other arrangement

https://dchealth.dc.gov/service/certificate-need

https://code.dccouncil.us/dc/council/code/sections/44-401.html

https://code.dccouncil.us/dc/council/code/sections/44-406.html


Puerto Rico

Health Care Facility Licensing/Certification Agency: Puerto Rico Department of Health / Division of Certificates of

Convenience and Necessity


U.S. Virgin Islands

Health Care Facility Licensing/Certification Agency: United States Virgin Islands Department of Health


http://www.salud.gov.pr/Dept-de-Salud/Pages/Unidades-Operacionales/Secretaria-Auxiliar-de-Reglamentacion-Acreditacion-de-Facilidades-de-Salud.aspx

http://www.salud.gov.pr/Dept-de-Salud/Pages/Unidades-Operacionales/Secretaria-Auxiliar-de-Reglamentacion-Acreditacion-de-Facilidades-de-Salud.aspx

https://doh.vi.gov/programs