Certificate of Need (CON)- What is it, Steps to obtain and future changes to the law.
What is it:
A certificate of need is a regulatory process that requires healthcare providers to obtain approval from the Department of Health and Human Services before developing or adding new healthcare facilities, expanding existing facilities or expanding services.
The laws vary from state to state but are intended to prevent overutilization, control healthcare costs and ensure healthcare resources are allocated efficiently.
Steps to obtain:
Application submittal: Healthcare providers or organizations seeking to build new, expand or add certain medical services must apply for a CON.
Public Comment Period: First 30 days after reviewing any person may file comments supporting concerning proposals.
Public Hearing: Held in the service area where the project intends to be developed.
Application Review: Regulatory authority access whether there is a demonstrated need.
Competitive Review: Different providers may submit applications for the same or similar services and the agency determines that the approval of one or more may result in the denial of another application.
Appeals of Decisions: Within 30 days after the date of the decision, any person affected may file a petition for a contested case hearing.
Monitoring of project development: After issuance, the agency will monitor development requiring provider to submit progress reports.
Enforcement: Withdrawal of a certificate can occur if the provider does not develop in a consistent manner with the representations made on the application or not developed in a timely manner.
Future Changes to the law:
NC general Assembly passed legislation that would expand Medicaid for approx. 600,000 residents of North Carolina who lack health care coverage. Included in the Medicaid expansion bill are notable reforms to the CON Law. The reforms primarily affect Ambulatory Surgical Centers, behavioral health and chemical dependency providers, MRI providers, and diagnostic centers.
The most notable change to the law is both single and multispecialty ASC’s in counties with populations over 125,000 will no longer be subject to the CON Statue.
These changes are stated to be the most significant alterations to the CON law since inception. If approved, the changes will make is notably easier for healthcare providers to develop and offer needed health care services to NC.