{
  "name": "Certificate of Need capital expenditure thresholds by US state \u2014 dollar thresholds by facility type, covered services, reviewing agencies, and program status",
  "description": "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 About 35 states plus DC have CON programs; ~15 states have repealed them.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'.",
  "url": "https://referencesource.org/con-capital-expenditure-thresholds-by-state/",
  "licence": "unknown",
  "last_verified": "2026-08-15",
  "stale_after": "2027-08-15",
  "sources": [
    "https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg&section=19-120"
  ],
  "records": [
    {
      "state": "Maryland",
      "con_program_status": "active",
      "hospital_capital_threshold": "the lesser of 25% of the hospital's gross regulated charges for the immediately preceding year or $50,000,000",
      "non_hospital_capital_threshold": "N/A \u2014 non-hospital CON is triggered by bed capacity changes or new medical services, not a dollar threshold",
      "bed_change_trigger": "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",
      "covered_services": "cardiac surgery, organ transplant surgery, burn or neonatal intensive care, home health, hospice, freestanding ambulatory surgical centers",
      "reviewing_agency": "Maryland Health Care Commission",
      "repeal_date": "N/A",
      "statutory_citation": "Md. Code, Health-General \u00a719-120",
      "id": "maryland",
      "url": "https://referencesource.org/con-capital-expenditure-thresholds-by-state/maryland/",
      "source": "https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg&section=19-120",
      "source_quote": "Hospital capital threshold” means the lesser of: (i) 25% of the hospital’s gross regulated charges for the immediately preceding year; or (ii) $50,000,000.",
      "verified_fields": [
        "hospital_capital_threshold"
      ]
    }
  ]
}