North Carolina 2026 Draft State Medical Facilities Plan and Summer Petitions

The North Carolina State Health Coordinating Council (SHCC) has published its draft 2026 State Medical Facilities Plan (SMFP.)  All summer petitions to amend the draft and comments on the draft have been published. This blog post will address:

• The SMFP process
• The assets available under the Draft 2026 SMFP
• The petitions and comments submitted to the following SHCC subcommittees:
  • Acute Care Services
  • Long Term and Behavioral Health
  • Technology and Equipment

SMFP Process

The SMFP is a governing document for healthcare planning in North Carolina and provides projections of need for CON-reviewable facilities and services. It summarizes supply and utilization for each facility and service, describes projection methods and policies, and provides other data relevant to need projections. The North Carolina CON agency can only approve additional assets that are shown as needed in the SMFP.

Development of the 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 to amend the SMFP that have potential for statewide effect, including requests for addition, deletion or revision of policies of need methodologies. The summer petition period occurs after the Agency has considered the spring petitions and published a Proposed SMFP in early July. Summer petitions involve requests for changes in specific need determinations in the Proposed SMFP.  Members of the public can also submit general comments about need determinations during the summer petition period. Both spring and summer petitions/comments are published on the Agency website with a two-week public comment period on individual petitions. Each petition is assigned to its appropriate SHCC committee which makes recommendations to the full SHCC.

Services with a Published Need in the Draft 2026 SMFP

The table below shows the needs published in the Draft 2026 SMFP. There is a published need for acute care beds in nineteen service areas, six of which have a need for over 100 beds. There is also a need for adult care home beds, several categories of major medical equipment, and hospice home care.

Summer Petitions and Comments

Fifteen petitions and eight comments were submitted during the summer petition period. Below are brief summaries of each petition, organized by the applicable SHCC committee. Each summary includes a link to the petition, with a link to any comments on that petition.

Acute Care Services Committee

Petitions

Atrium Health, Inc. submitted a petition to add a need determination for one heart-lung bypass machine in Mecklenburg County.  Their petition points out that the state SMFP guidelines have not had a mechanism to calculate the need for additional heart-lung bypass machines since the methodology was removed in 2012.

UNC Hospitals also submitted a petition for one heart-lung bypass machine to be added in Orange County.   Their petition also identifies that since 2012 the addition of these machines has been facilitated through Summer petitions.  UNC Hospitals also provided three physician letters in support of this petition.  The heart-lung machine in Orange County is being specifically requested due to the existence of:

• Significant operational challenges created by the current geographic separation of cardiac and surgical services in different towers at the main campus; and
• The lack of dedicated emergency backup equipment for non-open-heart cases.

Pender Memorial Hospital d/b/a Novant Health Pender Medical Center again submitted a petition to remove the need for 43 acute care beds in Pender County. The petition states there was a data anomaly in the Hospital Industry Data Institute (HIDI) acute care days which caused an error in the resulting bed need projections. In Table 5A of the Proposed 2025 SMFP, non-acute care bed days were included in NH Pender’s HIDI data. The petition states that, once the error is corrected, it will remove the potential for unnecessary duplication due to additional beds in Pender County. No letters of support or formal opposition were received for this petition.

Long-Term and Behavioral Health Committee

Petitions

Boost Home Healthcare submitted a petition for an exemption to the need determination methodology contained in Chapter 8 of the 2025 State Medical Facilities Plan (SMFP).  The current methodology indicates no need for additional Medicare-certified home health agencies in Union County.  The petition states that without an exemption for this agency there could be adverse impacts to medically underserved communities in the region.   Atrium Health submitted comments in opposition to this petition.

AMOREM Support submitted a pair of petitions seeking to remove the need determination for additional hospice home care offices in Burke County and in McDowell County.  The petitions site the calculations used to determine need for hospice services are based on data which is heavily impacted by Covid-19 deaths.  As a result, mortality displacement from Covid-19, the population of individuals needing hospice services in the years immediately following may be less than the data projects.    Pruitt Health submitted comments in opposition to both the Burke  County and McDowell  County petitions.

Citing similar concerns with the pull-forward nature of the deaths associated with Covid-19 and the inverse demand for hospice services that could be attributed to fatalities from vulnerable populations, the following petitions were submitted for the following counties:

• ANCORA Compassionate Care submitted a petition to remove the need determination for one new hospice home care office in Rockingham County.
• VITAS Healthcare Corporation of North Carolina submitted a petition to remove the need determination for one new hospice home care office in Cumberland County.
• Four Seasons submitted a petition to remove the need determination for one new hospice home care office in Haywood County.

Pruitt Health submitted comments in opposition to both the Rockingham County and Haywood County petitions.  Hospice of North Carolina also submitted comments in opposition to the Haywood County petition.

Technology and Equipment Committee

MRI Petitions

Raleigh Radiology, LLC. submitted a petition requesting the SHCC either:

• Adopt a new technology policy that would allow a qualified applicant in Wake County to apply to replace a qualified MRI service agreement with a permanent fixed MRI scanner.

Or

• Adjust the need determination for a replacement of one additional Fixed MRI scanner in Wake County.

Either solution would be employed to fill the demand gap associated with a current “grandfathered” MRI in the region which is planned to be relocated outside of this region prior to the next SMFP.

Linear Accelerator Petitions

Four separate petitions were submitted to the SHCC for linear accelerators during the Summer petition period.  The petitions identify patient needs that the petitioners state are not quantified using the current need determination methodology.  These submittals proposed to allow for additional linear accelerators in four service areas as outlined below:

In addition to these petitions for standard linear accelerators, Raleigh Neurosurgical Clinic petitioned the SHCC for a self-shielded, stereotactic radiosurgery (“SRS”)-dedicated linear accelerator.  Benefits of this technology include elimination of the need for a radiation vault, a lower total cost of ownership and a potential for better patient experience (due in part to prolonged employee contact and a more open environment with less shielding.)   The SRS linear accelerator is being requested to provide safer access to quality linear accelerator technology at an increased value to the patient.

Next Steps to the Final 2026 SMFP

After the public comments period, the Agency recommends whether the SHCC should approve, deny or alter the need determination adjustment request. Agency recommendations are discussed at the next SHCC committee meetings where committee members vote to approve, deny or alter the Agency’s recommendations. The committees forward their recommendations to the full SHCC. At their final meeting, the SHCC considers all information provided and makes its final recommendation for the 2026 SMFP. The recommended final 2026 SMFP is presented to Governor Josh Stein who may approve it as recommended or make any changes he deems appropriate. The deadline for final approval of the 2026 SMFP by the Governor is December 31, 2025.

The State Health Coordinating Council is scheduled to meet next on October 1^st 2025.

The following committee meetings have also been scheduled:

Acute Care Services Committee

• Tuesday, September 9, 2025

Long Term and Behavioral Health Committee

• Thursday, September 11, 2025

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