1. Certificate of Public Need in Other States
Susan Puglisi, Esq.
Senior Policy Analyst
Virginia Department of Health Office of Licensure and Certification
July 1, 2015

2. Overview and History
Certificate of Public Need is more commonly called Certificate of Need (CON) in other states.
Many CON laws were initially put into effect as part of the federal Health Planning Resources Development Act of 1974.
35 states including Virginia and the District of Colombia have some form of CON in place.

3. Overview

4. State by State: What is regulated?
Note: CON is alive and well in SC despite the note on this chart

5. State by State: What is Regulated?
Regulated Services
Number of States
Nursing Home Beds/Long Term Care Beds
35+DC (including VA)
Acute Hospital Beds
28 (including VA)
Ambulatory Surgical Centers
27 (including VA)
Long Term Acute Care
26 + DC (including VA)
Cardiac Catheterization
26 (including VA)
Psychiatric Services
Rehabilitation
25 (including VA)
Open Heart Surgery
Radiation Therapy
23 (including VA)
Neo-Natal Intensive Care
23 (including VA)

6. State by State: What is Regulated?
Regulated Services
Number of States
Intermediate Care Facilities for Individuals with Intellectual Disability(ICF/IID)
22 (including VA)
Organ Transplants
21 (including VA)
Positron Emission Tomography
20 (including VA)
Substance/ Drug Abuse 19
Magnetic Resonance Imagining
18 + DC (including VA)
Home Health 18
Hospice
Mobile Hi Technology (CT/MRI/PET, etc)
15 + DC (Including VA)
Obstetrics Services
15 (including VA)
Gamma Knives
“Additional services regulated” listed in BOLD are subject to COPN in Va
Additional services regulated: Air Ambulance, Ambulance services, Burn Care, CT scanners, Lithotripsy, Medical Office Buildings, Renal Failure/Dialysis, Assisted Living Facilities, Subacute Services, Swing Beds, & Ultrasound

7. State by State: The Review Process
VA – 190 days, the longest review period
Alabama 50 days
Alaska 60 days
Arkansas Review is done on a published schedule; 90 days
Connecticut 90 days
Delaware 90 days
D.C. 60 days
Florida 60 days
Georgia 120 days
Hawaii 90 days
Illinois 120 days
Iowa 60 days
Kentucky 90 days
Louisiana 60 days
Maine 90 days
Maryland 150 days
Massachusetts 4 months (120 days)
Michigan 120 days
Mississippi 90 days
Missouri 130 days
Montana 90 days
Nebraska 60 days
Nevada 75 days
New Hampshire 90 days
New Jersey 180 days
North Carolina 90 days
Ohio 60 days
Oklahoma 45 days
Oregon 90 days
Rhode Island 120 days
South Carolina 120 days
Tennessee 60 days
Vermont 120 days
Virginia 190 days
Washington 90 days
West Virginia 90 days

8. State by State: Who holds the Authority
Alabama Certificate of Need Review Board
Alaska Commissioner
Arkansas Health Services Permit Commission
Connecticut Office of Health Care Access
Delaware Bureau of Health Planning and Resources Management
D.C. State Health Planning and Development Agency
Florida Agency for Health Care Administration
Georgia Department of Community Health
Hawaii Administrator of the State Health Planning & Development Agency
Illinois Health Facilities and Services Review Board
Iowa Department of Public Health
Kentucky Cabinet for Health and Family Services
Louisiana Bureau of Health Services Financing, Health Standards Section, Facility Need Review Program
Maine Commissioner of the Department of Health and Human Services
Maryland Maryland Health Care Commission
Massachusetts Department of Public Health
Michigan Director of the Michigan Department of Community Health
Mississippi State Health Officer
Missouri Missouri Health Facilities Review Committee
Montana Department of Public Health and Human Services
Nebraska Department of Health and Human Services
Nevada Director of the Department of Health and Human Services
New Hampshire Health Services Planning and Review Board
New Jersey State Commissioner of Health and Senior Services
New York Commissioner of Health
North Carolina Certificate of Need Section in the Department of Health and Human Services
Ohio Director of Health
Oklahoma State Commissioner of Health
Oregon Public Health Division
Rhode Island Rhode Island Department of Health
South Carolina Department of Health and Environmental Control
Tennessee Tennessee Health Services and Development Agency
Vermont Green Mountain Care Board
Virginia State Health Commissioner
Washington Secretary of the Washington State Department of Health
West Virginia West Virginia Health Care Authority

9. State by State: Application Fees
State(s)
Maximum Fee
South Carolina
$7,000
Delaware
$10,000
New Hampshire & Alabama
$12,000
Michigan
$15,000
Ohio, Vermont, Virginia
$20,000
Iowa
$21,000
Kentucky
$25,000
Tennessee
$45,000
Washington
$46,253
Florida, Georgia, & North Carolina
$50,000
Mississippi & Alaska
$75,000
Oregon
$90,000
Illinois & West Virginia
$100,000
Maine
$250,000
D.C.
$300,000
Alabama 1% of estimated cost, max of $12,000
Alaska $2,500 for projects under $2.5 million 0.1% of projects more than $2.5 million; max of $75,000
Arkansas $3,000
Connecticut $500
Delaware Based on Capital Expenditure, Max $10,000
D.C. 3% of the capital expenditure; min $5,000; max $300,000
Florida 0.15% of capital expenditure; min $10,000; max $50,000
Georgia 0.1% of the total cost; min $1,000; max $50,000
Hawaii $ % of the capital expenditure; and additional 0.05% for expenditures in excess of $1 million
Illinois 0.22% of the project cost; min $2,500; max $100,000
Iowa 0.3% of the anticipated cost of the project; min $600; max $21,000
Kentucky 0.5 % of the capital expenditure; min $1,000; max $25,000
Louisiana $200
Maine 0.1% of capital expenditure; min $5,000; max $250,000
Massachusetts 0.2% of proposed capital expenditures; min $250
Michigan Based on Project cost: min $3,000; max $15,000
Mississippi 0.75% of proposed capital expenditure; min $1,250; max $75,000
Missouri 0.1% of the total project cost; min $1,000
Montana 0.3% of the capital expenditure; min $500
Nebraska $1,000
Nevada $9,500
New Hampshire 0.25% of the capital cost; min $500; max $12,000; Board also supported by administrative fee on all regulated entities collected annually
New Jersey 0.25 % of Total Project Cost +$7,500
New York $2, % of costs, or $2, % of costs
North Carolina $5, % of capital expenditure; max $50,000
Ohio 1.5% of the capital expenditure; min $5,000; max $20,000
Oklahoma $3,000
Oregon Fee schedule based on costs; min $13,500; max $90,900
Rhode Island $ % of Capital Cost
South Carolina $ % of the total project cost; max $7,000 (issuance fee of $7,500 required for projects of $1.4 million and greater)
Tennessee 0.225% of capital expenditure; min $3,000; max $45,000
Vermont 0.125% of project costs; min $250; max $20,000
Virginia 1% of proposed expenditure; min $1,000, max $20,000
Washington Based on facility type, min $12,874; max $46,253
West Virginia 0.1% of capital expenditure; min $1,500; max $100,000

10. State by State: Application Fees
State(s)
Minimum Fee
Vermont & Massachusetts
$250
Montana & New Hampshire
$500
Iowa
$600
Virginia, Georgia, Kentucky & Missouri
$1,000
Mississippi
$1,250
West Virginia
$1,500
Illinois
$2,500
Michigan & Tennessee
$3,000
D.C. Maine & Ohio
$5,000
Florida
$10,000
Washington
$12,874
Oregon
$13,500

11. State by State: Conditions
24 states permit conditional certificates
11 states do not have limitations set on what conditions can be placed on certificates
Those states which do have restrictions on conditions usually have the following restrictions:
The conditions must be related to the specific project
The conditions must be related to the CON statute and regulations
Virginia law is the most restrictive regarding conditions – prescribing which conditions may be used
Alaska Can include specifying a minimum period during which an activity must be available in the proposed service area
Delaware Conditions must be related to the specific project
D.C. Conditions must be related to adopted review criteria
Florida Permitted
Hawaii Conditions must directly relate to established law; conditions are on application must be modified
Illinois Conditions permitted
Kentucky Conditions permitted including limitations regarding services or patients
Maine Permitted
Massachusetts Permitted; should be related to making health care services reasonably available to every person within the state at the lowest reasonable aggregate cost
Michigan Permitted
Montana Permitted must be related to elements prescribed by statute
Nebraska Only permitted for long term care beds
Nevada Permitted; must be directly related to the proposed project and to the criteria used for review
New Hampshire Permitted; including the project amount, bed complement, patient charges, patient mix; other conditions.
New Jersey Permitted; Must relate to material presented in the application, state regulations and/or promote the intent of the CON statute
North Carolina Permitted; to be negotiated with applicant
Ohio Permitted
Oregon Permitted; must be directly related to the project and to review criteria placed in regulation
Rhode Island Permitted; some set out in regulation
South Carolina Permitted
Tennessee Permitted
Vermont Permitted
Virginia Permitted; prescribed by regulation
Washington Permitted; must be related to the project being reviewed and review criteria
West Virginia Permitted; must be related to criteria found in the Statute and Regulations. Only permissible for 3 year.

12. State by State: Review Moratoria
Alabama
Moratoria on nursing homes and in-patient hospice beds
Florida
Moratorium for additional community nursing home beds lifted July 2014
Louisiana
Moratorium on nursing homes
Mississippi
Moratorium on home health agencies and long term care facilities
Nebraska
Moratoria on nursing home and rehabilitation beds; certain exceptions
New Hampshire
Moratoria on nursing homes, skilled nursing facilities, intermediate care facilities and rehabilitation facilities. Rehabilitation beds.

13. State by State: Review Moratoria
New Jersey, Virginia
Long Term Care Applications are subject to the issuance of a call for applications
Rhode Island
Moratorium on Nursing facility beds

14. State by State: Monitoring
28 states require some form of monitoring after a certificate is issued
21 States require progress reports
Some required quarterly
Others due at specific benchmarks
10 States require annual reporting
A majority of states require some form of financial and cost reporting
1 state requires all CON regulated facilities to report annually
Alaska Annual expenditure; Development of project until completed
Arkansas Progress report at construction, foundation, and ever 6 months until the project is licensed.
Connecticut All hospitals are required to submit certain financial and statistical data annually
D.C. Quarterly progress reports
Florida Status report due after the first 15 months; Annual compliance reports for certificates with conditions.
Georgia All CON regulated facilities must provide annual reports; CON holders must submit progress report within 12 months and after completion of each phase
Hawaii Periodic reports as the agency requires
Illinois Annual progress reports
Iowa Progress reports required; first required six months after approval; Annual reporting required
Kentucky Biennial review; Annual survey
Maine Periodic reports must be submitted every 6 months, Cost and utilization reports every 6 months, & summary report when the service becomes operational.
Maryland Quarterly progress reports beginning 3 months after certificate is issued
Massachusetts Progress reports required for the first two years re: conditions
Mississippi Progress reports every 6 months and at completion
Missouri Progress reports every 6 months
Montana Annual reports required
Nevada Quarterly progress reports required
New Hampshire Implementation reports required: 30 days after CON issued, semi-annually during development; annually after commencement
New Jersey Progress reports required for CONs with conditions, at least 12 months from the date of approval and annually for the first 2 years after project implementation.
North Carolina Progress Reports required
Oklahoma Can be required by the Commissioner
Rhode Island ProgOregon Progress reports once every three months; report on completion
ress reports required at 6 month intervals
South Carolina Monthly progress reports and a final completion report
Vermont Reporting requirements placed on certificate
Virginia Progress reports required on annually until completion of the project. Conditioned COPNs required to report compliance with condition annually.
Washington Quarterly progress reports
West Virginia Due 45 days prior to the expiration of the certificate

15. NO CON: State by State 15 states currently do not have a CON program:
Arizona, California, Colorado, Idaho, Indiana, Kansas, Minnesota, New Mexico, North Dakota, Pennsylvania, South Dakota, Texas, Utah, Wisconsin, & Wyoming
In 1987, the federal government repealed the CON mandate and throughout the 1980s, states began retiring their CON programs. By states repealed their CON program. By 2000 an additional 3 had repealed their programs. Since 2000, Wisconsin is the only state to repeal it’s program.

16. Questions?