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Legislators in several states with Certificate of Need (CON) laws have introduced legislation to revise which services are subject to CON review. Proposed legislation in Kentucky, Maryland, Mississippi, and Tennessee would change the existing requirements for facility expansion, equipment acquisition, and service initiation. These changes may shift the way healthcare facilities, practitioners, and other investors make healthcare investments in these states.
RPC has 45 years of experience helping healthcare clients work with CON requirements and procedures, as well as providing market analysis and service line development.
The following summarizes the current legislative activity in these four states:
Kentucky: House Bill 407
Kentucky House Bill 407 would exempt several services from CON review. The bill would allow non-substantive review for replacement, relocation and cost escalations for current facilities or projects. The bill also mandates non-substantive review for ASC applications if the applicant was in operation as a private physician office before October 1, 2006. The bill also proposes to restrict the ability to request public hearings and file judicial appeals primarily to the applicant, limiting the ability of existing providers to challenge applicants that receive state approval.
A House Committee Substitute bill was introduced that retains the original provisions restricting public hearings but adds a requirement for the Cabinet for Health and Family Services to establish a formal procedure for requesting information from current CON holders regarding an application. The bill was approved by the House Health Services Committee by a 10-5 margin, signaling legislative support for the bill.
Maryland: House Bill 944 & Senate Bill 494
Maryland Senate Bill 494 and House Bill 944 would increase oversight of healthcare mergers and acquisitions. These companion bills would remove existing exemptions to increase oversight of organizational changes under the CON process. Under the new rules, mergers, acquisitions, and affiliation changes would require 90-day notice and a public interest review by the Maryland Health Care Commission. The criteria for these reviews would include impacts on price, quality, equity, and access, reflecting a state-level commitment to monitoring how corporate consolidation affects the local healthcare market.
Mississippi: House Bill 3
Mississippi House Bill 3 enacted changes to the CON program previously vetoed by the Governor. Governor Tate Reeves signed HB 3 into law on February 4, 2026. The legislation makes it easier for medical facilities to make capital investments. The new law raised the minimum dollar amount for capital expenditures requiring a CON from $2 million to $5 million, and the threshold for the acquisition of major medical equipment requiring a CON from $1.5 million to $3.5 million.
The legislation also has specific provisions that mandate approval of CONs for specialized facilities, such as psychiatric residential treatment in DeSoto County and community living programs in Madison County. The law also requires the University of Mississippi Medical Center to seek state approval for identified expansion plans, ensuring that large state entities are integrated into the broader health planning framework. Notably absent from the bill signed this session was the provision to grant a CON for Oceans Behavioral Hospital in Jackson.
Tennessee: Senate Bill 1369 & Amendment HA0594
The overriding aim of SB 1369 and its subsequent amendment, HA0594 is the eventual elimination of Certificate of Need requirements for establishing acute care hospitals, freestanding emergency departments (FSEDs) and cardiac catheterization laboratories. While the original draft aimed for a 2028 sunset for CON requirements for acute care hospital, the latest amendment extends the timeline to July 1, 2030. The legislation seeks to exempt freestanding emergency departments (FSED) and cardiac catheterization services affiliated with a hospital from CON requirements on July 1, 2027. As of April 6, 2026, the amended bill has been approved in the Senate and has been placed on the Regular House Calendar for its consideration.
Tennessee: House Bill 2278 Senate Bill 2414
At the same time the Tennessee legislature is proposing extending the CON requirements to 2030, the state is also considering HB 2278 which will terminate the Certificate of Public Advantage (COPA) for Ballad Health. The bill, having passed the House, is currently being reviewed by the Senate. As the bills work their way through the legislature, the US Federal Trade Commission (FTC) has issued concerns that the combination of the bills “would create a two-year gap between the Ballad Health COPA expiration in 2028 and the removal of the CON requirement for acute care hospitals in 2030[1].” The FTC warns that the potential lack of competition and potential merger-related harm could have a negative impact on healthcare costs and quality for consumers in the state.
[1] FTC Letter to Tennessee Rep. David Hawk Concerning Certificate of Public Advantage and Certificate of Need requirements. Available at: https://www.ftc.gov/system/files/ftc_gov/pdf/FTC-Letter-re-TN-COPA-CON-Bills.pdf
If you have questions or a project you would like to discuss, please contact Regulatory Manager Darcy Schaeffer, MLS, at 512.371.8011, dscheaffer@rpcconsulting.com