Certificate of Need capital expenditure thresholds by US state — dollar thresholds by facility type, covered services, reviewing agencies, and program status
State-by-state comparison of Certificate of Need (CON) program requirements for healthcare facilities. Each record is one state with whether it has a CON program (and repeal date if not), the capital expenditure threshold that triggers CON review for hospitals and for non-hospital facilities, whether bed capacity changes trigger review (and at what level), the reviewing agency, and the statutory citation. Thresholds range from $1.5 million (Iowa) to $50 million (Maryland) for hospitals. About 35 states plus DC have CON programs; ~15 states have repealed them. Answers 'does my hospital expansion need a Certificate of Need', 'what is the CON threshold for an ASC in [state]', and 'which states have eliminated CON requirements'.
Records13
Sources13
Verified
Review by
Licenceunknown
The data
| State | CON program status | Hospital capital threshold ($) | Non-hospital capital threshold ($) | Reviewing agency | Repeal date | Statutory citation | Bed change trigger | Services requiring CON |
|---|---|---|---|---|---|---|---|---|
| Delaware | active | in excess of $5.8 million, or some greater amount designated by the Board following an annual adjustment for inflation | in excess of $5.8 million, or some greater amount designated by the Board following an annual adjustment for inflation | Delaware Health Resources Board | N/A | 16 Del. C. §9304 | ||
| District of Columbia | active | $6 million or more | $3.5 million in connection with a health service or health facility | State Health Planning and Development Agency (SHPDA) | N/A | DC Official Code 44-401 et seq. (Health Services Planning Program Reestablishment Act of 1996, as amended); Certificate of Need Regulations, Title 22B, DC Municipal Regulations, Sec. 4000 et seq. | Redistribute the beds of a health care facility by 10 beds or 10 percent, whichever is less, in any two-year period. | new health care facility, health care service or home health agency; major medical equipment ($3.5 million by a hospital, $2 million by a healthcare facility, or a single diagnostic/therapeutic device over $350,000); relocation of beds; new health services not offered in the previous 12 months; renal dialysis stations; acquisition of an existing facility or major medical equipment |
| Hawaii | active | $4,000,000 for capital expenditures | $4,000,000 for capital expenditures, $1,000,000 for new or replacement medical equipment and $400,000 for used medical equipment | state health planning and development agency | N/A | Haw. Rev. Stat. §323D-2 | ||
| Iowa | active | in excess of one million five hundred thousand dollars within a twelve-month period | in excess of one million five hundred thousand dollars within a twelve-month period; new services costing over five hundred thousand dollars are separately reviewable | N/A | Iowa Code §135.61(16)(c) | a permanent change in the bed capacity, as determined by the department, of an institutional health facility | ||
| Maine | active | any capital expenditure of $10,000,000 or more (adjusted annually for medical-care inflation) | capital expenditures of $5,000,000 or more for nursing facilities; more than $5,000,000 (or more than $3,000,000 in specified cases) for ambulatory surgical facilities | N/A | 22 M.R.S. §329 | |||
| Maryland | active | the lesser of 25% of the hospital's gross regulated charges for the immediately preceding year or $50,000,000 | N/A — non-hospital CON is triggered by bed capacity changes or new medical services, not a dollar threshold | Maryland Health Care Commission | N/A | Md. Code, Health-General §19-120 | for non-hospitals, increase or decrease exceeding the lesser of 10% of total bed capacity or 10 beds in a 2-year period; for hospitals, changes in bed capacity require CON with exceptions for transfers within merged asset systems | cardiac surgery, organ transplant surgery, burn or neonatal intensive care, home health, hospice, freestanding ambulatory surgical centers |
| Missouri | active | one million dollars in the case of capital expenditures, excluding major medical equipment, and one million dollars in the case of medical equipment | for long-term care beds, six hundred thousand dollars in the case of capital expenditures, or four hundred thousand dollars in the case of major medical equipment | Missouri Health Facilities Review Committee | N/A | RSMo §197.305 | ||
| North Carolina | active | a capital expenditure exceeding four million dollars ($4,000,000) | a capital expenditure exceeding four million dollars ($4,000,000); major medical equipment costing more than two million dollars ($2,000,000) is separately reviewable | N/A | N.C. Gen. Stat. §131E-176(16)b | |||
| Rhode Island | active | in excess of five million two hundred fifty thousand dollars ($5,250,000), adjusted annually by CPI-U | in excess of five million two hundred fifty thousand dollars ($5,250,000); new healthcare equipment with capital costs exceeding $2,250,000 is separately reviewable | Rhode Island state department of health | N/A | R.I. Gen. Laws §23-15-2(10) | any capital expenditure that results in the addition of a health service or that changes the bed capacity of a healthcare facility; nursing facility bed increases up to the greater of ten beds or ten percent of licensed capacity may be exempted | |
| South Carolina | limited | N/A — following 2023 Act No. 20, Certificate of Need requirements apply only to nursing homes | for nursing homes, in excess of an amount to be prescribed by regulation | N/A | S.C. Code §44-7-160 | a change in the existing bed complement of a nursing home through the addition of one or more beds or change in the classification of licensure of one or more beds | ||
| Virginia | active | no general dollar threshold for general hospitals — projects such as new facilities, bed additions, and specified services are reviewable by category under the Certificate of Public Need law | any capital expenditure of $15 million or more by or on behalf of a medical care facility other than a general hospital (revised annually for inflation) | N/A | Va. Code §32.1-102.1:3(B)(8) | |||
| Washington | active | no dollar threshold — hospital certificate of need review is triggered by construction of new facilities, changes in bed capacity, and new tertiary health services rather than by a capital expenditure amount | for nursing homes, $1,000,000 adjusted by the department by rule | Washington State Department of Health | N/A | RCW 70.38.105; RCW 70.38.025(5) | ||
| West Virginia | active | at and above $100 million | at and above $100 million | West Virginia Health Care Authority | N/A | W. Va. Code §16-2D-2(15) |
Where this came from
Every record above links the page it was taken from and quotes the sentence that states it. These are the 13 sources this dataset was assembled from.
- delcode.delaware.govhttps://delcode.delaware.gov/title16/c093/index.html
- dchealth.dc.govhttps://dchealth.dc.gov/service/certificate-need
- capitol.hawaii.govhttps://www.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0323D/HRS_0323D-0002.htm
- legis.iowa.govhttps://www.legis.iowa.gov/docs/code/135.61.pdf
- legislature.maine.govhttps://legislature.maine.gov/statutes/22/title22sec329.html
- mgaleg.maryland.govhttps://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg§ion=19-120
- revisor.mo.govhttps://www.revisor.mo.gov/main/OneSection.aspx?section=197.305
- ncleg.govhttps://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_131E/GS_131E-176.html
- webserver.rilegislature.govhttps://webserver.rilegislature.gov/Statutes/TITLE23/23-15/23-15-2.htm
- scstatehouse.govhttps://www.scstatehouse.gov/code/t44c007.php
- law.lis.virginia.govhttps://law.lis.virginia.gov/vacode/32.1-102.1:3/
- app.leg.wa.govhttps://app.leg.wa.gov/rcw/default.aspx?cite=70.38.025
- code.wvlegislature.govhttps://code.wvlegislature.gov/16-2D-2/
Machine-readable
- data.jsonThe whole dataset — every record with its source URL and source quote.
- Open Knowledge Format bundleOne JSON object per line — every record's frontmatter and quoted span exactly as it is held here, in one fetch.
- data.csvThe same records as one flat table, for a spreadsheet or a dataframe. The last four columns are the source URL, the quoted sentence it was read from, the date we last checked it, and which columns are our reading rather than the page's words.
- How this is made and checkedWhat "verified against source" does and does not mean.
From your own code
Same records, same quotes, without scraping the page: refsource is on PyPI and npm. Each value comes back carrying the URL it was read from and the sentence on that page that states it — .source and .quote sit on the value itself rather than in a side channel, so the checking step is available instead of skipped.
pip install refsource
refsource lookup con-capital-expenditure-thresholds-by-state state=Delaware
npx -y refsource lookup con-capital-expenditure-thresholds-by-state state=DelawareSet your AI assistant up to use this
Two files and no account. Put this in .mcp.json at the root of your project — Claude Code, Cursor, Windsurf, VS Code and Codex all read that file — and your assistant can look this dataset up instead of recalling it. The server is remote, keyless and read-only.
{
"mcpServers": {
"referencesource": {
"type": "http",
"url": "https://referencesource.org/mcp"
}
}
}Add to Cursor · or, on the command line: claude mcp add --transport http referencesource https://referencesource.org/mcp --scope project
Then one line in the project's CLAUDE.md or AGENTS.md, so the assistant knows when to reach for it:
When a question needs "Certificate of Need capital expenditure thresholds by US state — dollar thresholds by facility type, covered services, reviewing agencies, and program status", call the referencesource MCP server at https://referencesource.org/mcp (tool `search_records`, dataset_slug `con-capital-expenditure-thresholds-by-state`) instead of answering from memory — every record it returns carries its source URL and a verbatim quote from that page.What each tool does, and the servers built over single registers: Connect your AI assistant.