South Carolina Certificate of Need (CON) Program

South Carolina Certificate of Need (CON) Introduction

The South Carolina Department of Health and Environmental Control administers the South Carolina CON program. The purpose of South Carolina’s CON program is to promote cost containment, prevent unnecessary duplication of health care facilities and services, guide the establishment of health facilities and services that will best serve public needs, and ensure that high-quality services are provided in health facilities in the State.

Contents last updated on July 2024

Services that Require CON

South Carolina requires CON approval for nursing home facilities, home health agencies, hospitals (general or specialized), and the addition of beds at a hospital. CON review is no longer required in South Carolina for the relocation of a hospital within the same county or the construction of a new hospital of 50 beds or less in a county that does not have an existing hospital. Nursing home projects that involve acquiring medical equipment over the monetary threshold or making capital expenditures over a certain threshold ($2,000,000) also require CON review.

The following services no longer require CON review in South Carolina, after a 2023 legislative change:

• Ambulatory surgical facilities
• Opioid treatment programs
• Freestanding emergency departments
• Hospice facilities
• Residential treatment facilities for children and adolescents
• Cardiovascular care services
• Radiation therapy services (linear accelerator)

What Criteria are Used to Review a CON?

The Department of Health and Environmental Control is required to notify an applicant of the relative importance of the project review criteria to be used in reviewing its’ application. This notification is made once an application is deemed complete. The criteria to be used in reviewing all CON projects are listed below. There are additional project-specific criteria, including numeric need formulas for some services. No project shall be approved unless it is consistent with the State Health Plan.

• Need for the proposed project, which includes accessibility and distribution of health resources
• Economic considerations, which include the financial feasibility of the project, projected revenues, funding, financing, consideration of alternatives, and cost containment.
• Health system resources, which includes staffing considerations, adverse impact on existing facilities, and access to professional schools and training programs
• Site suitability, which includes zoning, utilities, site size, environmental considerations and square footage
• Special considerations:
  • Medically underserved groups
  • Other entities (medical schools, training schools, multidisciplinary clinics)
  • Safety

Certificate of Need Process Milestones

1. Public Notification Within twenty (20) days prior to submission of an application, the applicant must file notification in the legal section of a daily newspaper in the project’s proposed service area. The notification must run for three consecutive days and must include: 1) a statement that a CON is being applied for; 2) a description of the project; and 3) the estimated project capital cost.
2. Application Submission Applications are submitted using a web-based portal on the DHEC website, or by any other means the department provides. A non-refundable filing fee of $500 is required within 20 calendar days of the public notification.
3. Additional Information Within 15 calendar days of accepting an application, the Department can request any additional information deemed necessary to make the application complete. The applicant has 15 days from the date of the request to submit the requested information. If no additional information is submitted, the application is withdrawn from review.
4. Payment of Application Fee When the application is deemed complete, the Department will invoice the applicant for the CON fee, which must be paid by check within fifteen calendar days of receipt. When the application fee is complete, the Department will publish a notice in the State Register that the review cycle has begun. The application fee is one half of one percent of the total project cost, and shall not exceed $7,000.
5. Public Hearing A hearing can be requested by an affected person within 30 days of notification of the beginning of the review. The public hearing provides an opportunity for any person to present information relevant to the application.
6. Decision The Department will make its decision on the application no earlier than 30, but no later than 90 calendar days from the date of publication in the State Register, unless a public hearing is held, in which case the decision will be rendered no later than 120 days after affected parties are notified the application was deemed complete.
7. Appeals Department decision involving the issuance, denial, or revocation of a CON may be appealed by an affected person.
8. Progress Updates The applicant is required to submit quarterly progress reports that correspond with the timetable included in the approved CON, beginning 90 days after receipt of the CON certificate. The applicant must submit a final completion report after the project has been fully implemented, containing information on total project costs, design specifications, services and equipment inventory, and a list of average charges and costs for services.

Certificate of Need Application Fees

The non-refundable initial filing fee is $500. The application fee is one half of one percent (.5%) of the total project cost, which is payable when the project is deemed complete. The application fee shall not exceed $7,000.

South Carolina also has a CON issuance fee of $7,500 for any project with a total cost exceeding $1,400,000. This fee is payable within fifteen days of receipt of the CON certificate.

Additional Sources

(links good as of January 2024)

South Carolina Department of Health and Environmental Control, Certificate of Need
https://scdhec.gov/healthcare-quality/certificate-need-con

2023 CON Act Frequently Asked Questions
https://scdhec.gov/sites/default/files/media/document/2023-Jun-S164-Act-No20-FAQ.pdf

CON Statute (Section 44-7-110 to 44-7-230)
https://www.scstatehouse.gov/code/t44c007.php

CON Regulations
https://scdhec.gov/sites/default/files/Library/Regulations/R.61-15.pdf

State Health Plan
https://scdhec.gov/sites/default/files/media/document/2024%20SHP%20%20Final%203-8-2024%20%282%29.pdf

CON Application Forms
https://scdhec.gov/certificate-need-application-con