Learn how to advocate for these model policies in your state


Current Certificate of Need policies vary widely across the states, but they share a need to be updated to reflect the shifting realities of the health care landscape. As the hospital industry continues to move towards more consolidation, and there are an increasing number of rural hospital closings, it is important to ensure that state oversight policies like Certificate of Need can be utilized to protect access to care. Patient access to care will only be protected if consumers can meaningfully participate in the Certificate of Need review process by being fully informed and having the ability to provide testimony about the potential impact on their communities. 

1. Criteria for triggering CON: 

  • Ideally, a CON would be required any time a hospital is involved in a sale, purchase, lease, affiliation or transfer of board control.
  • It would also be required when the proposed transaction would result in a loss of services, with services defined to include reproductive health services such as tubal ligations, abortions, and contraceptive counseling.

2. Organizational structure of review board and transparency: 

  • The review board should be required to include members of the community and consumer advocates, as well as health experts from various fields. 
  • The review board should be required to include members of the community, consumer advocates as well as health experts from various fields. 
  • No more than 50% of the members should be representatives of institutional health care providers because of their tendency to vote for each other’s projects and move each other forward.

3. Review standards: 

  • The standards for reviewing a CON should be publicly available and established by regulation/statute. 
  • The review should include a comprehensive, independently performed health needs assessment that analyzes health needs of the community (defined broadly), the availability of services in the community, transportation and other access needs and a comprehensive assessment of the impact of the proposed change on the availability and access to key services. Alternatively, if an existing state health planning document identifies the health needs of the affected hospital service area, it can be used in the review process.

4. Communications with the public: 

  • To ensure that the CON process is transparent and consumers can have the opportunity to meaningfully engage in review of proposed changes to the hospitals in their community, the Department of Health (or similarly situated department handling CON in the state) should provide adequate information to the public, focusing on anyone likely to be impacted by the transaction. Information should be in multiple languages, culturally sensitive, and easy to access in multiple platforms. 
  • There should an easily navigable website with all relevant CON documents available for download. There should be summaries of each proposed transaction including the above required impact statements written in plain English and other languages spoken in the community. All information about regulations, meetings and details about submitting comments should be available on this website in an easy to find, easy to read format. 
  • All such information should also be submitted to at least one local newspaper for publication, posted in local health centers and distributed to local officials who can disseminate the information to their constituencies.

5. Accountability and public engagement

  • Most vital to a more robust CON process is the way it facilitates and relies on meaningful public engagement. There should be an opportunity for affected members of the public, and their representatives, to obtain key CON documents submitted by the applicants and to submit written comments on CON applications.
  • In addition, for hospital CON applications, there should be a requirement that public hearings should be held at the location of the proposed transaction, (as opposed to only in the state capital) upon request by affected consumers. 
  • There should be time allotted for testimony from consumers and advocates.

6. Post approval review and enforcement

  • In addition to hearings and comments during the approval process, a robust CON process will include the ability for the public to request a post-approval review, or a have the ability to appeal any decision made on the CON. 
  • There needs to be an enforcement mechanism in place whereby the Department of Health or another regulatory body must perform a review of the CON conditions at one year, two year and five year intervals to ensure requirements are being carried out.