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Certificate of Need: State Health Laws and Programs

The first certificate of need [CON] program was implemented by New York state in 1964, and other states followed after the 1974 National Health Planning Resources Development Act required that states develop a structure to review major health care capital projects involving new construction or investment in high cost technology. The intent was reduce or restrain costs by coordinating new construction and services based on need. Nearly all states had developed health care planning controls by the late 1970s, but the federal law and the related funding for states was repealed in 1987.

Currently, 36 states still maintain some type of CON program, but the programs vary in scope. The National Conference of State Legislatures has published a useful overview of CON programs, covering their intent and structure, the views of CON supporters and opponents, alternative approaches to CON, which states have or don’t have CON programs, and what facilities or services are regulated by which states. Web links are provided to the CON programs in those states that have them or to health planning agencies in the other states without CON laws.


Certificate of need: state health laws and programs. National Conference of State Legislatures, Sept. 2015. http://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx

CON background. American Health Planning Association, accessed Jan. 8, 2016 at http://www.ahpanet.org/copnahpa.html

Mitchell M and Coopman C. 40 years of certificate-of-need laws across America. Mercatus Center, George Mason University, Oct. 14, 2014. http://mercatus.org/publication/40-years-certificate-need-laws-across-america

Related resources:

Lee T and others. Health care certificate-of-need laws: policy or politics. National Institute for Health Care Reform Research Brief, no. 4, May 2011. http://www.nihcr.org/index.php?download=119ncfl17

Rosko MD and Mutter RL. The association of hospital cost-inefficiency with certificate-of-need regulation. Medical Care Research and Review 71(3):280-298, June 2014. http://www.ncbi.nlm.nih.gov/pubmed/24452139

Jacobs BL and others. Certificate of need regulations and the diffusion of intensity-modulated radiotherapy. Urology 80(5): 1015-1020, Nov. 2012. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505690/

Lorch SA and others. The impact of certificate of need programs on neonatal intensive care units. Journal of Perinatology 32(1):39-44, Jan. 2012. http://www.ncbi.nlm.nih.gov/pubmed/21527902

Update Jan. 13, 2016: Stratmann T and Baker MC. Are certificate of need laws barriers to entry? How they affect access to MRI, CT, and PET scans. Mercatus Center, George Mason University, Working Paper, Jan. 12, 2016. http://mercatus.org/publication/are-certificate-need-laws-barriers-entry-how-they-affect-access-mri-ct-and-pet-scans


Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

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