Start a business · Certificate of need
Certificate of need laws by state
Whether each state requires state approval (a certificate of need) before you open or expand a health facility or service, which services it covers, and what the review costs and takes.
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States still being compiled are marked; a state is published only once confirmed against its official source.
| State | CON program | Services covered | Agency |
|---|---|---|---|
| Alabama | Yes | hospitals (general, specialized, psychiatric, long-term care), skilled nursing facilities, intermediate care… | Alabama State Health Planning and Development Agency (SHPDA)… |
| Alaska | Yes | hospitals (including psychiatric and tuberculosis hospitals), skilled nursing facilities / nursing home beds… | Alaska Department of Health (decision by the commissioner) |
| Arizona | No | — | Arizona Department of Health Services (ambulance certificates of… |
| Arkansas | Yes | nursing facilities, assisted living facilities, residential care facilities, home health agencies, hospice… | Arkansas Health Services Permit Agency (under the Arkansas Department… |
| California | No | — | — |
| Colorado | No | — | — |
| Connecticut | Yes | new health care facilities (hospitals, specialty hospitals), freestanding emergency departments, outpatient… | Connecticut Office of Health Strategy, Health Systems Planning Unit… |
| Delaware | Yes | hospitals, nursing homes, freestanding surgical centers, freestanding birthing centers, freestanding acute… | Delaware Health Resources Board, staffed by the Bureau of Health… |
| District of Columbia | Yes | hospitals (general, psychiatric, rehabilitation, specialty), skilled nursing facilities, intermediate care… | State Health Planning and Development Agency (SHPDA), DC Health |
| Florida | Yes | community nursing homes / skilled nursing facility beds, hospice programs and hospice inpatient facilities… | Florida Agency for Health Care Administration (AHCA) |
| Georgia | Yes | hospitals (including destination cancer hospitals), special care units, skilled nursing facilities… | Georgia Department of Community Health (DCH), Office of Health… |
| Hawaii | Yes | hospitals, extended care and rehabilitation centers, nursing homes / skilled nursing facilities, intermediate… | Hawaii State Health Planning and Development Agency (SHPDA) |
| Idaho | No | — | — |
| Illinois | Yes | hospitals, ambulatory surgical treatment centers, skilled and intermediate long-term care facilities (nursing… | Illinois Health Facilities and Services Review Board (HFSRB), staffed… |
| Indiana | Yes | comprehensive care health facilities (nursing homes): new facilities, added beds, bed transfers and Medicaid… | Indiana Department of Health (Long-Term Care) |
| Iowa | Yes | hospitals, health care facilities as defined in Iowa Code 135C.1 (nursing facilities, ICF/ID, ICF for persons… | Iowa Department of Health and Human Services (CON program staff and… |
| Kansas | No | — | — |
| Kentucky | Yes | hospitals, ambulatory surgical centers, home health agencies, hospice (including residential hospice by a… | Kentucky Cabinet for Health and Family Services, Office of Inspector… |
| Louisiana | Yes | nursing facilities and nursing facility beds (licensed and Medicaid-certified), HCBS providers: personal care… | Louisiana Department of Health, Health Standards Section (FNR program) |
| Maine | Yes | hospitals and psychiatric hospitals, nursing facilities, kidney disease treatment centers / freestanding… | Maine Department of Health and Human Services (CON Unit, Division of… |
| Maryland | Yes | hospitals and limited service hospitals, related institutions (including comprehensive care facilities /… | Maryland Health Care Commission (MHCC) |
| Massachusetts | Yes | hospitals and clinics, long-term care facilities, nursing homes, rest homes and charitable homes for the… | Massachusetts Department of Public Health, Determination of Need… |
| Michigan | Yes | new health facilities and changes in bed capacity, covered capital expenditures of $2,500,000+ (indexed… | Michigan Department of Health and Human Services, Certificate of Need… |
| Minnesota | No | — | Minnesota Department of Health (moratorium exceptions and public… |
| Mississippi | Yes | nursing home care services (skilled nursing and ICF), ICF/IID and nursing care for persons with developmental… | Mississippi State Department of Health, Office of Health Policy and… |
| Missouri | Yes | beds in long-term care facilities licensed under RSMo chapter 198 and hospital long-term care beds… | Missouri Health Facilities Review Committee, staffed by the… |
| Montana | Yes | long-term care facilities (skilled nursing, intermediate nursing and intermediate developmental disability… | Montana Department of Public Health and Human Services |
| Nebraska | Yes | new long-term care beds (nursing facility beds), long-term care bed increases above 10 beds or 10% (whichever… | Nebraska Department of Health and Human Services |
| Nevada | Yes | new construction by or for any health facility costing more than the greater of $2,000,000 or a regulatory… | Nevada Department of Health and Human Services, Director (health… |
| New Hampshire | No | — | New Hampshire Department of Health and Human Services (facility… |
| New Jersey | Yes | long-term care (general, ventilator, pediatric), rehabilitation beds, psychiatric beds, new general hospitals… | New Jersey Department of Health, Certificate of Need and Healthcare… |
| New Mexico | No | — | New Mexico Health Care Authority, Division of Health Improvement… |
| New York | Yes | hospitals, nursing homes, diagnostic and treatment centers (including ambulatory surgery and dialysis)… | New York State Department of Health, Division of Planning &… |
| North Carolina | Yes | new health service facilities (hospitals, nursing homes, adult care homes, kidney disease treatment centers… | NC Department of Health and Human Services, Division of Health… |
| North Dakota | No | — | North Dakota Department of Health and Human Services (facility… |
| Ohio | Yes | long-term care facilities: licensed nursing homes and skilled nursing / long-term care beds (including county… | Ohio Department of Health (Director of Health) |
| Oklahoma | Yes | long-term care facilities as defined in 63 O.S. §1-851.1 (licensed nursing facility beds), ICF/IID beds… | Oklahoma State Department of Health, Health Facility Systems |
| Oregon | Yes | new hospitals, new skilled nursing or intermediate care services or facilities (long-term care), including… | Oregon Health Authority, Public Health Division (Certificate of Need… |
| Pennsylvania | No | — | — |
| Rhode Island | Yes | hospitals, nursing facilities, home nursing-care providers, home-care providers, hospice providers and… | Rhode Island Department of Health (state agency), with review by the… |
| South Carolina | Yes | nursing homes: new facilities, bed additions or licensure reclassification, and capital expenditures above… | South Carolina Department of Public Health, Certificate of Need… |
| South Dakota | No | — | South Dakota Department of Health (nursing facility bed moratorium… |
| Tennessee | Yes | hospitals, nursing homes (and nursing home bed increases beyond the lesser of 10 beds or 10% once every 3… | Tennessee Health Facilities Commission (HFC) |
| Texas | No | — | — |
| Utah | No | — | Utah Department of Health and Human Services, Division of Integrated… |
| Vermont | Yes | construction, purchase, renovation or capital expenditure by a health care facility above $10,000,000… | Green Mountain Care Board (GMCB) |
| Virginia | Yes | hospitals, including DBHDS-licensed psychiatric hospitals, nursing homes and new nursing home services… | Virginia Department of Health; the State Health Commissioner issues… |
| Washington | Yes | new health care facilities: hospitals, behavioral health hospitals, nursing homes, hospices and hospice care… | Washington State Department of Health, Certificate of Need Program |
| West Virginia | Yes | establishment or acquisition of any health care facility (broadly defined), capital expenditures above the… | West Virginia Health Care Authority |
| Wisconsin | Yes | construction of new nursing homes, nursing home bed capacity increases, nursing home capital expenditures… | Wisconsin Department of Health Services |
| Wyoming | No | — | — |