Capital expenditure dollar amounts that trigger certificate-of-need (CON) review in each US state with a CON program. Each record is one state, giving the expenditure threshold by facility type (hospital, long-term care, other), whether the threshold is inflation-adjusted, which facility types and services are covered, whether there is a moratorium on new facilities, and the statute citation. Answers 'how much can I spend on a healthcare facility project in [state] before I need a CON' and 'does [state] require a CON for [hospital beds / imaging equipment / ambulatory surgery centers]'.

Facts extracted from state government health department pages and NCSL legislative overview; statutory thresholds are not copyrightable

Certificate of need capital expenditure thresholds by US state


**State:** Alabama

**Has CON program:** yes

**Hospital threshold:** $4,000,000

**Long-term care threshold:** $4,000,000

**General threshold:** $4,000,000

**Major equipment threshold:** $2,000,000

**Covered services:** general hospitals, specialized hospitals, nursing facilities, intermediate care facilities, rehabilitation centers, hospice service providers, home health agencies, HMOs, ambulatory surgery centers, kidney disease treatment centers

**Moratorium:** no

**Statute citation:** Ala. Code § 22-21-260

> Capital expenditures greater than: $2,000,000 for major medical equipment. $800,000 for new annual operating costs. $4,000,000 for any other capital expenditures.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Alabama — Certificate of need capital expenditure thresholds by US state

covered_services, has_con_program, moratorium, state, statute_citation


**State:** Alaska

**Has CON program:** yes

**Hospital threshold:** $1,000,000

**Long-term care threshold:** $1,000,000

**General threshold:** $1,000,000

**Covered services:** hospitals, psychiatric hospitals, independent diagnostic testing facilities, residential psychiatric treatment centers, skilled nursing facilities, kidney disease treatment centers, intermediate care facilities, ambulatory surgical facilities

**Moratorium:** no

**Statute citation:** Alaska Stat. § 18-07-31 et seq.

> Capital expenditures greater than $1 million that include: Constructing a new health care facility. Altering the bed capacity of a health care facility. Adding a new category of health services provided at the facility. Converting a building or part of a building to a nursing home requiring state licensure.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Alaska — Certificate of need capital expenditure thresholds by US state

capital_threshold_general, capital_threshold_hospital, capital_threshold_ltc, covered_services, has_con_program, moratorium, state, statute_citation


**State:** Arizona

**Has CON program:** no

**Moratorium:** no

> Although Arizona does not operate an official CON program, the state requires an application for ambulance services and ambulances to be filed with the Department of Health Services, Bureau of Emergency Medical Services & Trauma System

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Arizona — Certificate of need capital expenditure thresholds by US state


**State:** Arkansas

**Has CON program:** yes

**Covered services:** nursing home facilities, residential care facilities, assisted living facilities, post-acute head injury retraining facilities, home health care services agencies

**Moratorium:** Constructing a new residential care facility. Replacing a residential care facility with 16 beds or more. Adding new beds or expanding existing bed capacity for residential care facilities.

**Statute citation:** Ark. Stat. Ann. § 20-8-109 et seq.

> Constructing a nursing home. Adding new long-term care beds or expanding existing long-term care bed capacity. Adding or expanding home health services. Creating hospice programs.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Arkansas — Certificate of need capital expenditure thresholds by US state


**State:** California

**Has CON program:** no

**Moratorium:** no

> Certificate of Need Law | No

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

California — Certificate of need capital expenditure thresholds by US state


**State:** Colorado

**Has CON program:** no

**Moratorium:** no

> Certificate of Need Law | No

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Colorado — Certificate of need capital expenditure thresholds by US state


**State:** Connecticut

**Has CON program:** yes

**Covered services:** hospitals, specialty hospitals, free-standing emergency departments, outpatient surgical facilities, mental health facilities, substance abuse treatment facilities, nursing homes, rest homes, residential care homes

**Moratorium:** no

**Statute citation:** Conn. Gen. Stat. § 19a-638 (General Health Facilities) | Conn Gen. Stat. 17b-352 (Long Term Care Facilities)

> Capital expenditures exceeding a certain statutory limit.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Connecticut — Certificate of need capital expenditure thresholds by US state


**State:** Delaware

**Has CON program:** yes

**Hospital threshold:** $5,800,000

**Long-term care threshold:** $5,800,000

**General threshold:** $5,800,000

**Inflation-adjusted:** yes

**Covered services:** hospitals, nursing homes, free-standing birthing centers, free-standing surgical centers, free-standing acute inpatient rehabilitation hospitals, free-standing emergency centers, continual care community and other non-traditional long-term care facilities

**Statute citation:** Del. Code Ann. Tit. 16 § 9301 et seq.

> Capital expenditures greater than $5.8 million or another amount adjusted for inflation.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Delaware — Certificate of need capital expenditure thresholds by US state

capital_threshold_general, capital_threshold_hospital, capital_threshold_ltc, covered_services, has_con_program, inflation_adjusted, state, statute_citation


**State:** Florida

**Has CON program:** yes

**Covered services:** skilled nursing facilities, hospices, intermediate care facilities for the developmentally disabled

**Statute citation:** Fla. Stat. § 408.031 et seq.

> Adding beds to community nursing homes or intermediate care facilities for the developmentally disabled. Constructing or establishing additional health care facilities. Converting from one type of health facility another. Establishing a hospice or hospice inpatient facility.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Florida — Certificate of need capital expenditure thresholds by US state


**State:** Georgia

**Has CON program:** yes

**Hospital threshold:** $10,000,000

**Long-term care threshold:** $10,000,000

**General threshold:** $10,000,000

**Covered services:** hospitals, destination cancer hospitals, skilled nursing facilities, intermediate care facilities, personal care homes, ambulatory surgical facilities, obstetrical facilities, free-standing emergency departments, HMOs, home health agencies, diagnostic, treatment and rehabilitation centers

**Statute citation:** Ga. Code § 31-6-40 et seq.

> Capital expenditures more than $10 million.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Georgia — Certificate of need capital expenditure thresholds by US state

capital_threshold_general, capital_threshold_hospital, capital_threshold_ltc, covered_services, has_con_program, state, statute_citation


**State:** Hawaii

**Has CON program:** yes

**Covered services:** hospitals, surgical centers, extended care and rehabilitation centers, nursing homes, skilled nursing facilities, intermediate care facilities, hospices, kidney disease treatment centers, outpatient clinics, ambulatory health care facilities, emergency care facilities, home health agencies, HMOs

**Moratorium:** no

**Statute citation:** Hawaii Rev. Stat. § 323D-42 et seq.

> Constructing, expanding, altering, converting, developing, initiating or modifying a health care facility or health care services that exceeds the capital expenditure minimum.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Hawaii — Certificate of need capital expenditure thresholds by US state


**State:** Idaho

**Has CON program:** no

**Moratorium:** no

> Certificate of Need Law | No

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Idaho — Certificate of need capital expenditure thresholds by US state


**State:** Illinois

**Has CON program:** yes

**Covered services:** hospitals, long-term care facilities, dialysis centers, ambulatory surgery centers, alternative health care delivery models, free-standing emergency centers, birthing centers

**Moratorium:** no

**Statute citation:** Ill. Rev. Stat. ch. 20, § 3960/1 et. seq.

> Constructing or modifying by or on behalf of a health care facility that exceeds the capital expenditure minimum. Acquiring and housing major medical equipment.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Illinois — Certificate of need capital expenditure thresholds by US state


**State:** Indiana

**Has CON program:** yes

**Covered services:** comprehensive care facilities (nursing homes)

**Moratorium:** no

**Statute citation:** Ind. Code § 16-29-7 et seq.

> Building, developing or establishing a new health care facility. Moving an existing health care facility to another county. Relocating beds from one facility to another. Changing the comprehensive bed capacity of a health care facility.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Indiana — Certificate of need capital expenditure thresholds by US state


**State:** Iowa

**Has CON program:** yes

**Hospital threshold:** $1,500,000

**Long-term care threshold:** $1,500,000

**General threshold:** $1,500,000

**Major equipment threshold:** $1,500,000

**Covered services:** hospitals, residential care facilities, nursing facilities, intermediate care facilities, outpatient surgical facilities, community mental health facilities, birthing centers

**Moratorium:** no

**Statute citation:** Iowa Code § 135.61 et seq.

> No | Additional Comments | After having initially repealed their CON program, Indiana re-established a CON program in 2018 pursuant to <http://iga.in.gov/legislative/2018/bills/senate/190#digest-heading> SB 190 . | Iowa Iowa Health Care Facility Licensing/Certification Agency |

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Iowa — Certificate of need capital expenditure thresholds by US state

capital_threshold_general, capital_threshold_hospital, capital_threshold_ltc, covered_services, has_con_program, major_equipment_threshold, statute_citation


**State:** Kansas

**Has CON program:** no

**Moratorium:** no

> Certificate of Need Law | No

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Kansas — Certificate of need capital expenditure thresholds by US state


**State:** Kentucky

**Has CON program:** yes

**Covered services:** hospitals, psychiatric hospitals, physical rehabilitation hospitals, chemical dependency programs, nursing facilities, nursing homes, personal care homes, intermediate care facilities, outpatient clinics, ambulatory care facilities, ambulatory surgical centers, emergency care centers, ambulance providers, hospices, community mental health centers, home health agencies, kidney disease treatment centers

**Moratorium:** no

**Statute citation:** Ky. Rev. Stat. § 216B.020 et seq.

> Obligating a capital expenditure which exceed the capital expenditure minimum.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Kentucky — Certificate of need capital expenditure thresholds by US state


**State:** Louisiana

**Has CON program:** yes

**Covered services:** nursing facilities, intermediate care facilities for persons with developmental disabilities, home- and community-based service providers, hospice providers, pediatric day health care facilities, behavioral health services providers, opioid treatment programs

**Moratorium:** Intermediate care facilities for the developmentally disabled. Nursing facilities (until July 1, 2027).

**Statute citation:** La. Rev. Stat. Ann. § 2116

> The Louisiana Department of Health notes it operates a Facility Need Review (FNR) process rather than a Certificate of Need program. However, most researchers identify Louisiana as a CON state, because its FNR process operates similar to that of a CON program.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Louisiana — Certificate of need capital expenditure thresholds by US state

covered_services, has_con_program, moratorium, statute_citation


**State:** Maine

**Has CON program:** yes

**Hospital threshold:** $10,000,000

**Long-term care threshold:** $10,000,000

**General threshold:** $10,000,000

**Covered services:** hospitals, psychiatric hospitals, nursing facilities, kidney disease treatment centers, rehabilitation facilities, ambulatory surgical facilities, independent radiological service centers, independent cardiac catheterization centers, cancer treatment centers

**Moratorium:** no

**Statute citation:** Me. Rev. Stat. Ann. Tit. 22, Chapter 103-A et seq.

> Capital expenditures of $10 million or more.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Maine — Certificate of need capital expenditure thresholds by US state


**State:** Maryland

**Has CON program:** yes

**Hospital threshold:** lesser of 25% of the hospital's gross regulated charges for the preceding year or $50 million

**Covered services:** hospitals, limited-service hospitals, related institutions providing domiciliary, personal or nursing care, ambulatory surgical facilities, rehabilitation facilities, home health agencies, hospices

**Moratorium:** no

**Statute citation:** Md. Health Code Ann. § 19-120 et seq.

> No | Additional Comments | N/A | Maryland Maryland Health Care Facility Licensing/Certification Agency |

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Maryland — Certificate of need capital expenditure thresholds by US state

capital_threshold_hospital, covered_services, has_con_program, statute_citation


**State:** Massachusetts

**Has CON program:** yes

**Major equipment threshold:** $250,000

**Covered services:** hospitals or clinics, long-term care facilities, clinical laboratories, public medical institutions

**Moratorium:** no

**Statute citation:** Mass. Gen. Laws Ann. ch. 111 §25C et seq.

> Substantial capital expenditures for constructing or substantially changing health services. Acquiring medical equipment for more than $250,000.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Massachusetts — Certificate of need capital expenditure thresholds by US state


**State:** Michigan

**Has CON program:** yes

**Covered services:** hospitals, psychiatric hospitals or psychiatric units, nursing homes or hospital long-term care units, free-standing surgical outpatient facilities, HMOs

**Moratorium:** no

**Statute citation:** Mich. Comp. Laws § 333.22201 et seq.

> Making a covered capital expenditure that exceeds the capital expenditure threshold.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Michigan — Certificate of need capital expenditure thresholds by US state


**State:** Minnesota

**Has CON program:** no

**Moratorium:** Hospitals and hospital beds (Minn. Stat. § 144.551). Nursing home beds (Minn. Stat. § 144A.071). Intermediate care facilities for persons with developmental disabilities (Minn. Stat. § 252.291). Radiation therapy facilities in certain counties (Minn. Stat. § 144.5509).

> Minnesota does not operate a CON program. However, the state maintains moratoriums and processes for exceptions to moratorium for several health facilities.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Minnesota — Certificate of need capital expenditure thresholds by US state


**State:** Mississippi

**Has CON program:** yes

**Hospital threshold:** $5,000,000

**Long-term care threshold:** $5,000,000

**General threshold:** $5,000,000

**Major equipment threshold:** $3,500,000

**Covered services:** hospitals, psychiatric hospitals, chemical dependency hospitals, skilled nursing facilities, end-stage renal disease facilities, intermediate care facilities, ambulatory surgical facilities, home health agencies, psychiatric residential treatment facilities, pediatric skilled nursing facilities, long-term care hospitals, comprehensive medical rehabilitation facilities

**Moratorium:** Skilled nursing facilities. Intermediate care facilities. Converting hospitals beds to skilled or intermediate nursing home care. Medicaid-certified child/adolescent psychiatric or chemical dependency beds. Intermediate care facilities for the intellectually disabled.

**Statute citation:** Miss. Code Ann. § 41-7-171 et seq.

> The new law raised the minimum dollar amount for capital expenditures requiring a CON from $2 million to $5 million, and the threshold for the acquisition of major medical equipment requiring a CON from $1.5 million to $3.5 million.

Source: <https://rpcconsulting.com/potential-certificate-of-need-change-legislation/>

Mississippi — Certificate of need capital expenditure thresholds by US state

capital_threshold_general, capital_threshold_hospital, capital_threshold_ltc, covered_services, has_con_program, major_equipment_threshold, moratorium, state, statute_citation


**State:** Mississippi

**Has CON program:** yes

**Covered services:** hospitals, psychiatric hospitals, chemical dependency hospitals, skilled nursing facilities, end-stage renal disease facilities, intermediate care facilities, ambulatory surgical facilities, home health agencies, psychiatric residential treatment facilities, pediatric skilled nursing facilities, long-term care hospitals, comprehensive medical rehabilitation facilities

**Moratorium:** Skilled nursing facilities. Intermediate care facilities. Converting hospitals beds to skilled or intermediate nursing home care. Medicaid-certified child/adolescent psychiatric or chemical dependency beds. Intermediate care facilities for the intellectually disabled.

**Statute citation:** Miss. Code Ann. § 41-7-171 et seq.

> Constructing, developing or establishing a new health care facility. Relocating a health facility. Relocating major medical equipment to a site more than a mile away. Changing bed complement. Offering covered services not offered in previous 12 months.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>


**State:** Missouri

**Has CON program:** yes

**Covered services:** hospitals, residential care facilities, assisted living facilities, intermediate care facilities, skilled nursing facilities, long-term care beds in a hospital, long-term care hospitals

**Moratorium:** no

**Statute citation:** Mo. Rev. Stat. § 197.300 et seq.

> Developing a new health care facility. Acquiring, including by lease, any health care facility or major medical equipment. Capital expenditures by or on behalf of a health care facility. Predevelopment activities costing more than $150,000.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Missouri — Certificate of need capital expenditure thresholds by US state


**State:** Montana

**Has CON program:** yes

**Long-term care threshold:** $1,500,000

**General threshold:** $1,500,000

**Covered services:** long-term care facilities

**Moratorium:** no

**Statute citation:** Mont. Code Ann. § 50-5-301 et seq.

> Capital expenditures over $1.5 million. Changing bed capacity of a capacity of a facility through an increase in number, or relocation, of beds. Adding health services associated with annual operating expenses of $150,000 or more.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Montana — Certificate of need capital expenditure thresholds by US state

capital_threshold_general, capital_threshold_ltc, covered_services, has_con_program, moratorium, state, statute_citation


**State:** Nebraska

**Has CON program:** yes

**Covered services:** skilled nursing facilities, intermediate care facilities, nursing facilities, long-term care hospitals

**Moratorium:** Long-term care beds.

**Statute citation:** Neb. Rev. Stat. § 71-5829 et seq.

> Establishing long-term care beds. Increasing the long-term beds of a health facility by more than 10 or more than 10% of total beds in the facility. Establishing long-term beds through conversion by a hospital.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Nebraska — Certificate of need capital expenditure thresholds by US state

covered_services, has_con_program, state, statute_citation


**State:** Nevada

**Has CON program:** yes

**General threshold:** $2,000,000

**Covered services:** health facilities broadly defined as a facility in or through which health services are provided

**Moratorium:** no

**Statute citation:** Nev. Rev. Stat. § 439A.100 et seq.

> Capital expenditures above $2 million for constructing a new health care facility in rural counties. Construction is defined to include increasing the square footage to an existing health care facility or redesigning/renovating an existing building currently not used by a health facility.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Nevada — Certificate of need capital expenditure thresholds by US state

capital_threshold_general, covered_services, has_con_program, moratorium, state, statute_citation


**State:** New Hampshire

**Has CON program:** no

**Moratorium:** no

> New Hampshire repealed its CON program in 2016 pursuant to SB 481 and switched to a specialized licensure process for certain health facility projects, including establishing cardiac catheterization, open heart surgery and megavoltage radiation therapy services.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

New Hampshire — Certificate of need capital expenditure thresholds by US state


**State:** New Jersey

**Has CON program:** yes

**Hospital threshold:** $2,000,000

**Long-term care threshold:** $2,000,000

**General threshold:** $2,000,000

**Major equipment threshold:** $2,000,000

**Covered services:** general hospitals, special hospitals, mental hospitals, public health centers, diagnostic centers, treatment centers, rehabilitation centers, extended care facilities, skilled nursing homes, intermediate care facilities, assisted living residences, comprehensive personal care facilities, outpatient clinics, home health care agencies, residential health care facilities, bioanalytical laboratories

**Moratorium:** no

**Statute citation:** N.J. Rev. Stat. §26-2H-7 et seq.

> Purchasing major medical equipment exceeding $2 million. Capital expenditures exceeding $2 million.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

New Jersey — Certificate of need capital expenditure thresholds by US state


**State:** New Mexico

**Has CON program:** no

**Moratorium:** no

> Certificate of Need Law | No

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

New Mexico — Certificate of need capital expenditure thresholds by US state


**State:** New York

**Has CON program:** yes

**Covered services:** hospitals, nursing homes, diagnostic and treatment centers, ambulatory surgery centers, certified home health agencies, long term home health care programs, hospices, adult care facilities, adult day health care programs

**Moratorium:** no

**Statute citation:** N.Y. Public Health Law § 2802 et seq.

> Establishing or constructing new facilities, agencies, programs or hospices. Renovating existing facilities, agencies, programs or hospices. Acquiring major medical equipment. Adding or deleting health care services.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

New York — Certificate of need capital expenditure thresholds by US state


**State:** North Carolina

**Has CON program:** yes

**Covered services:** hospitals, long-term care hospitals, psychiatric facilities, rehabilitation facilities, nursing home facilities, adult care homes, kidney disease treatment centers, intermediate care facilities, home health agency offices, chemical dependency treatment facilities, diagnostic centers, hospice offices, hospice inpatient facilities, ambulatory surgical facilities

**Moratorium:** no

**Statute citation:** N.C. Gen. Stat. § 131E-175 et seq.

> No | Additional Comments | N/A | North Carolina North Carolina Health Care Facility Licensing/Certification Agency |

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

North Carolina — Certificate of need capital expenditure thresholds by US state


**State:** North Dakota

**Has CON program:** no

**Moratorium:** no

> Certificate of Need Law | No

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

North Dakota — Certificate of need capital expenditure thresholds by US state


**State:** Ohio

**Has CON program:** yes

**Long-term care threshold:** $4,000,000

**Covered services:** long-term care facilities

**Moratorium:** Long-term care beds.

**Statute citation:** Ohio Rev. Code Ann. § 3701-12-01 et seq.

> Renovating or adding to a long-term care facility involving a capital expenditure of $4 million or more.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Ohio — Certificate of need capital expenditure thresholds by US state

capital_threshold_ltc, covered_services, has_con_program, moratorium, state, statute_citation


**State:** Oklahoma

**Has CON program:** yes

**Long-term care threshold:** $1,000,000

**General threshold:** $1,000,000

**Covered services:** long-term care facilities, specialized facilities for developmentally disabled clients, hospital-based skilled nursing units

**Moratorium:** no

**Statute citation:** Okla. Stat. Tit. 63 § 1-850 et seq.

> Capital expenditures greater than $1,000,000 or more.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Oklahoma — Certificate of need capital expenditure thresholds by US state


**State:** Oregon

**Has CON program:** yes

**Covered services:** hospitals, skilled nursing facilities, intermediate care facilities, long-term care facilities, health facilities established by a health maintenance organization

**Moratorium:** no

**Statute citation:** Or. Rev. Stat. § 442-015 et seq.

> No | Additional Comments | N/A | Oregon Oregon Health Care Facility Licensing/Certification Agency |

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Oregon — Certificate of need capital expenditure thresholds by US state


**State:** Pennsylvania

**Has CON program:** no

**Moratorium:** no

> Certificate of Need Law | No

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Pennsylvania — Certificate of need capital expenditure thresholds by US state


**State:** Rhode Island

**Has CON program:** yes

**Covered services:** hospitals, nursing facilities, home nursing-care providers, home care providers, hospice providers, inpatient rehabilitation centers, free-standing emergency care facilities, facilities providing surgical treatment to patients not requiring hospitalization, facilities providing inpatient hospice care

**Moratorium:** New nursing facilities, nursing facility licensed beds, and increases in capacity of licensed nursing facilities (until July 1, 2022).

**Statute citation:** R.I. Gen. Laws § 23-15-2 et seq.

> Developing or establishing a new health care facility above a specified capital expenditure threshold. Offering services with a new piece of health care equipment above a specified capital expenditure threshold.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Rhode Island — Certificate of need capital expenditure thresholds by US state


**State:** South Carolina

**Has CON program:** yes

**Hospital threshold:** $5,000,000

**Long-term care threshold:** $5,000,000

**General threshold:** $5,000,000

**Major equipment threshold:** $1,500,000

**Covered services:** hospitals (except hospital care at home programs), nursing homes

**Moratorium:** no

**Statute citation:** S.C. Code Ann. § 44-7-110 et seq.

> Capital expenditures greater than $5 million.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

South Carolina — Certificate of need capital expenditure thresholds by US state


**State:** South Dakota

**Has CON program:** no

**Moratorium:** no

> Certificate of Need Law | No

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

South Dakota — Certificate of need capital expenditure thresholds by US state


**State:** Tennessee

**Has CON program:** yes

**Covered services:** nursing homes, recuperation centers, hospitals, ambulatory surgical treatment centers (to be exempted effective December 2027), mental health hospitals, intellectual disability institutional habilitation facilities (to be exempted effective December 2025), home care organizations, outpatient diagnostic centers, rehabilitation facilities, residential hospices, nonresidential substitution-based treatment center for opiate addiction, long-term care hospitals (to be exempted effective December 2027)

**Moratorium:** no

**Statute citation:** Tenn. Code Ann. § 68-11-1602 et seq.

> Constructing, developing or establishing a health care facility. Changing the licensed bed complement of a facility.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Tennessee — Certificate of need capital expenditure thresholds by US state


**State:** Texas

**Has CON program:** no

**Moratorium:** no

> Certificate of Need Law | No

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Texas — Certificate of need capital expenditure thresholds by US state


**State:** Utah

**Has CON program:** no

**Moratorium:** no

> Certificate of Need Law | No

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Utah — Certificate of need capital expenditure thresholds by US state


**State:** Vermont

**Has CON program:** yes

**Major equipment threshold:** $1,000,000

**Covered services:** general hospitals, mental hospitals, chronic disease facilities, birthing centers, maternity hospitals, psychiatric facilities, nursing homes, HMOs, home health agencies, outpatient diagnostic or therapy programs, kidney disease treatment centers, mental health agencies or centers, diagnostic imaging facilities, independent diagnostic laboratories, cardiac catheterizations laboratories, radiation therapy facilities, ambulatory surgical, diagnostic or treatment centers

**Moratorium:** No certificate of need can be granted for the offering of home health services, which includes hospices or new home health agencies, through Jan. 1, 2025, or until the General Assembly lifts the moratorium.

**Statute citation:** Vt. Stat. Ann. Tit. 18 V.S.A., § 9432 et seq.

> Purchasing, leasing or other comparable arrangement of a single piece of diagnostic and therapeutic equipment greater than $1 million. Offering a health care service or technology with an annual operating expense greater than $500,000.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Vermont — Certificate of need capital expenditure thresholds by US state

covered_services, has_con_program, major_equipment_threshold, moratorium, state, statute_citation


**State:** Virginia

**Has CON program:** yes

**Hospital threshold:** $5,000,000

**Long-term care threshold:** $15,000,000

**General threshold:** $15,000,000

**Covered services:** general hospitals, sanitariums, nursing homes, intermediate care facilities, extended care facilities, mental hospitals, facilities for individuals with developmental disabilities, psychiatric hospitals, rehabilitation hospitals, ambulatory surgery centers, cardiac catheterization centers, CT scanning centers, MRI centers, PET scanning centers, radiation therapy centers

**Moratorium:** None, but Certificates of Public Need for an increase in nursing beds are subject to the department issuing a request for applications for an increase in beds.

**Statute citation:** Va. Code §32.1-102.1 et seq.

> Capital expenditures of $15 million or more by a non-hospital facility and $5 million or more by a hospital.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Virginia — Certificate of need capital expenditure thresholds by US state


**State:** Washington, D.C.

**Has CON program:** yes

**Hospital threshold:** $6,000,000

**Long-term care threshold:** $3,500,000

**General threshold:** $3,500,000

**Major equipment threshold:** $3,500,000 (hospital) / $2,000,000 (other facility) / $350,000 (physician or independent owner/operator)

**Covered services:** private general hospitals, psychiatric hospitals, other specialty hospitals, rehabilitation facilities, skilled nursing facilities, intermediate care facilities, ambulatory care centers or clinics, ambulatory surgical facilities, kidney disease treatment centers, free-standing hemodialysis facilities, diagnostic health care facilities, home health agencies, hospices

**Statute citation:** D.C. Code Ann. § 44-401 et seq.

> Making capital expenditures of $6 million or more in connection with a hospital and $3.5 million in connection with a health service or health facility. Making a capital expenditure $3.5 million or more by a hospital, or $2 million by a health care facility to acquire major medical equipment. Acquiring by lease, purchase, donation or other comparable arrangement a single piece of diagnostic or therapeutic equipment by or on behalf of a physician, physician group or independent owner/operator. Applies to acquisitions above $350,000.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Washington, D.C. — Certificate of need capital expenditure thresholds by US state


**State:** Washington

**Has CON program:** yes

**Long-term care threshold:** $2,830,000

**Covered services:** hospices, hospice care centers, hospitals, psychiatric hospitals, nursing homes, ambulatory surgical facilities, home health agencies

**Moratorium:** no

**Statute citation:** Wash. Rev. Code §70-38-025 et seq.

> Nursing home capital expenditures greater than $2.83 million.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Washington — Certificate of need capital expenditure thresholds by US state


**State:** West Virginia

**Has CON program:** yes

**Covered services:** public or private facility, agency or entity that offers or provides health services, whether a for-profit or nonprofit entity

**Moratorium:** New intermediate care or skilled nursing beds. New skilled nursing facilities. New intermediate care beds for persons with intellectual disabilities. Opioid treatment programs (unless it is part of an approved clinical trial and registered with the Board of Pharmacy). In-home personal care services.

**Statute citation:** W. Va. Code §16-2D-2 et seq.

> Adding or expanding health care services. Activities exceeding a certain capital expenditures threshold. Obtaining major medical equipment valued above a certain amount. Developing or acquiring new health care facilities.

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

West Virginia — Certificate of need capital expenditure thresholds by US state


**State:** Wisconsin

**Has CON program:** no

**Moratorium:** Nursing homes are subject to a statewide bed limit. Hospital beds.

> Wisconsin Wisconsin Health Care Facility Licensing/Certification Agency | <https://www.dhs.wisconsin.gov/regulations/index.htm> Wisconsin Department of Health Services | Certificate of Need Law | No* | Recent Legislative Activity | N/A | Facilities and Activities Overview | Facilities Regulated Under Certificate of Need Laws | N/A | Activities Regulated Under Certificate of Need Law | N/A | Other Requirements | Moratorium | Nursing homes are subject to a statewide bed limit. Hospital beds. |

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Wisconsin — Certificate of need capital expenditure thresholds by US state


**State:** Wyoming

**Has CON program:** no

**Moratorium:** no

> Certificate of Need Law | No

Source: <https://www.ncsl.org/health/certificate-of-need-state-laws>

Wyoming — Certificate of need capital expenditure thresholds by US state