North Carolina 2027 State Medical Facilities Plan Draft

The North Carolina State Health Coordinating Council (SHCC) has published the draft of the 2027 State Medical Facilities Plan (SMFP). This blog post summarizes the need determinations and explains the remaining steps in the SMFP process:

• Overview of the SMFP process
• 2027 SMFP Timeline
• Services with a Need in the Proposed 2027 SMFP
• Summer Petitions and Comments to the SHCC

SMFP Process

The SMFP is a controlling document for the certificate of need (CON) process in North Carolina. It has data for each existing or approved facility and service, describes projection methods and policies, and provides other data for need projections. Unless the SMFP finds a need for a CON-reviewable facility or services in a single or multi-county planning area, there can be no CON application. Health care providers and facilities in North Carolina can only apply for assets the SMFP shows are needed. The need calculations are discussed and reviewed by members of four committees:

• Acute Care Services Committee
• Long Term and Behavioral Health Committee
• Technology and Equipment Committee
• Hospice Home Care Workgroup

Development of the annual SMFP is a continuous process with several opportunities for public comment. Two of these opportunities are the spring and summer petition periods. The spring petition period is intended for requests with potential statewide effect, including requests for  revision of methods for determining need. The summer petition period is for requests for changes in the need determinations in the draft SMFP.  Members of the public can also submit general comments about need determinations during the summer petition period. Both spring and summer petitions and comments are published on the Agency website. The public has two weeks to comment on individual petitions. Each petition is assigned to a SHCC committee for discussion and a recommendation to the full SHCC.

Completion and Final Sign-Off

The SHCC will review the petitions and the committee recommendations for the 2027 SMFP on September 30, 2026. The SHCC recommendation will then go to Governor Josh Stein who may approve it as recommended or make any changes he considers appropriate. The deadline for the Governor’s final approval is December 31, 2026.

2027 State Medical Facilities Plan Timeline 

Services with a Proposed Need in the proposed 2027 SMFP

The table below shows the needs published in the draft 2027 State Medical Facilities Plan (SMFP). The table shows a preliminary determination of the need for acute care beds in seven service areas, four of which have been determined to need over 50 beds. There are also needs shown for several categories of major medical equipment, for hospice services, and for inpatient rehab beds, nursing home beds, and adult care beds.

Summer Petitions and Comments Submitted

A total of 11 petitions and an additional 11 comments were submitted during the summer petition period. Below are summaries of each petition, organized by the applicable SHCC committee. Each summary has a link to the petition and a link to any comments on the petition.  The SHCC will discuss the petitions, make any changes to the draft SMFP, and take a final vote at its September 30,2026, meeting.

Acute Care Services Committee

Petitions

The Acute Care Services Committee received no summer petitions. Therefore, the acute care bed need determinations published in the Proposed 2027 State Medical Facilities Plan will not change. The Agency will forward these need determinations to the SHCC.

Long-Term and Behavioral Health Committee

Petitions

Carolina Caring submitted a petition requesting removal of the determination for an additional hospice home care office in Gaston County. The petition states that the projected need is largely the result of ​use data collected during the transition of Gaston Hospice to Carolina Caring on October 1, 2024. Carolina Caring argues that temporary disruptions associated with the ownership transition affected referral patterns and hospice usage during the reporting period and that more recent data show a recovery in deaths served and hospice usage in Gaston County. The petitioner also notes concerns regarding workforce fragmentation and unnecessary duplication of hospice services if an additional provider is approved. Oral remarks were presented to the Committee in connection with the petition as well as comments from VITAS and PruittHealth.

Lower Cape Fear LifeCare submitted a petition requesting an adjusted need determination for five additional hospice inpatient beds in Brunswick County. The petition argues that the current method understates demand due to the use of historical occupancy data and does not fully account for Brunswick County residents receiving inpatient hospice care outside the county. The petition cites growth in Brunswick County’s elderly population, increasing use of hospice inpatient services, and documented instances of patients remaining in acute care hospitals or being served at facilities outside the county due to limited local bed availability. The Committee received oral comments in support of the petition, and 4 letters of support.

Mountain Valley Hospice and Palliative Care submitted a petition requesting an adjusted need determination for four more hospice inpatient beds in Surry County. The petition contends that the standard hospice inpatient bed methodology understates actual demand because it does not fully account for respite care usage, out-of-state patients, and regional referral patterns. Mountain Valley argues that demand for inpatient hospice care has exceeded available capacity, resulting in waitlists, delayed admissions, and patients remaining in acute care hospital settings while awaiting hospice placement. The petition also cites demographic trends and a growing elderly population within its service area as evidence supporting additional capacity. The Committee received oral remarks in support of the petition, and 26 letters of support from community members and healthcare providers.

Mountain Valley Hospice and Palliative Care submitted a second petition requesting an adjusted need determination for two more hospice inpatient beds in Yadkin County. Similar to its Surry County petition, Mountain Valley argues that existing occupancy calculations do not fully capture total usage because licensed hospice beds are used for both general inpatient and respite care services. The petition cites sustained occupancy levels, increasing delays in hospice admissions, growing demand for inpatient hospice services, and projected growth in the Medicare-eligible population as justification for additional hospice inpatient capacity in Yadkin County. The Committee received oral remarks in support of the petition, and 14 letters of support from local hospitals, physicians, and community organizations.

Technology and Equipment Committee

Cardiac Catheterization Petition

Novant Health Thomasville Medical Center submitted a petition requesting an adjusted need determination for one more fixed cardiac catheterization laboratory in Davidson County. The petition argues that the current method does not identify a need despite increasing cardiovascular service demand in the service area. The petition also contends that population growth, an aging patient population, and continued growth in cardiac procedures support the addition of a fixed cardiac catheterization laboratory in Davidson County to improve access to diagnostic and interventional cardiac services.

Linear Accelerator Petitions

Three petitions were submitted seeking reductions or elimination of linear accelerator need determinations. The petitions argue that the revised method does not fully account for all factors relevant to determining the number and proper distribution of linear accelerators needed. The petitions request changes to linear accelerator need determinations in Health Service Area I, Health Service Area III, and Health Service Area V.

• • AdventHealth Hendersonville submitted a petition requesting removal of the need determination for more linear accelerators in Health Service Area I. The petition also argues for “deferring implementation of the revised LINAC methodology for at least one planning cycle while its potential effects are further evaluated.”
  • Novant Health Huntersville Medical Center submitted a petition requesting to remove the need determination for eight more linear accelerators in Health Service Area III. The petitioner states that the 8-LINAC need determination is generated mechanically by the methodology, not because HSA III lacks capacity. The petition requests a method change for this need determination too.
  • Novant Health Coastal Region submitted a petition requesting to reduce the need determination from two to one more linear accelerator in Health Service Area V. The petition argues that continued population growth and increasing demand for oncology services only justify one more radiation therapy site in the region.

With these petitions, the Agency proposed to limit determinations through the linear accelerator methodology published in the Proposed 2027 SMFP. The Agency proposed “limiting LINAC need determinations to one per service area until there is sufficient opportunity to further evaluate the impacts of the new methodology.” The Committee received nine comments and four oral remarks during the public hearing.

MRI Petition

Appalachian Regional Healthcare System submitted a petition requesting the removal of the need determination for one fixed MRI scanner in Watauga County. The petition states that existing MRI resources do not adequately reflect current usage patterns within the region and that an additional MRI would not improve access to advanced diagnostic imaging services for residents of the High Country. The Committee received oral remarks in support of the petition, and a comment opposing the petition and supporting the original need determination submitted by Scotland Health Care System.

PET Scanner Petitions

Two petitions for positron emission tomography (PET) services were submitted during the summer petition period. Cone Health submitted a separate comment regarding the need determination for HSA II.  Mission Hospital also submitted a comment on PET Scanner Need Determination Methodology.  Both petitions focus on access to advanced imaging services and contend that existing method and service distribution do not fully address current usage patterns.

• • Greenville Cardiology submitted a petition requesting a need determination for one more PET scanner in Health Service Area VI. The petition states that increasing demand for advanced cardiac and oncologic imaging supports the addition of PET capacity in the region. A comment in opposition was submitted by ECU Health.
  • Akumin Alliance Healthcare Services submitted a petition seeking an additional statewide mobile PET services. The petition argues that mobile PET technology can improve access to advanced imaging in areas that cannot support a fixed PET scanner and provides another approach to meeting demand for PET services across multiple service areas. The Committee received oral remarks in support of the petition, and a letter of support.

The full text of all comments and oral remarks is available on The North Carolina Division of Health Service Regulations – Planning and Certificate of Need – Petitions and Comments webpage.

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