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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

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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.

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Overview

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State by State: What is regulated?

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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 26 (including VA)

Rehabilitation 25 (including VA)

Open Heart Surgery 25 (including VA)

Radiation Therapy 23 (including VA)

Neo-Natal Intensive Care 23 (including VA)

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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 18

Mobile Hi Technology (CT/MRI/PET, etc) 15 + DC (Including VA)

Obstetrics Services 15 (including VA)

Gamma Knives 15 (including 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

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State by State: The Review Process

Less than 60 days

60 days 75 days 90 days 120 days more than 120 days

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Length of Review

# of States

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State by State: Who holds the Authority

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54

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Who Holds the Authority to issue CONs

DepartmentCommissionerReview BoardAgencyOfficeDirectorOther

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State by State: Application FeesState(s) Maximum Fee

South Carolina $7,000Delaware $10,000New Hampshire & Alabama $12,000Michigan $15,000Ohio, Vermont, Virginia $20,000Iowa $21,000Kentucky $25,000Tennessee $45,000Washington $46,253Florida, Georgia, & North Carolina $50,000Mississippi & Alaska $75,000Oregon $90,000Illinois & West Virginia $100,000Maine $250,000D.C. $300,000

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State by State: Application FeesState(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

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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

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State by State: Review MoratoriaState 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.

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State by State: Review MoratoriaState 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

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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

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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 1990 12 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.

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Questions?