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con-capital-expenditure-thresholds-by-state

con_program_status string	derived_fields list	hospital_capital_threshold string	id string	non_hospital_capital_threshold string	repeal_date string	reviewing_agency string	source string	source_quote string	state string	statutory_citation string	url string	verified_fields list	bed_change_trigger string	covered_services string
active	[ "con_program_status", "repeal_date", "state", "statutory_citation" ]	in excess of $5.8 million, or some greater amount designated by the Board following an annual adjustment for inflation	delaware	in excess of $5.8 million, or some greater amount designated by the Board following an annual adjustment for inflation	N/A	Delaware Health Resources Board	https://delcode.delaware.gov/title16/c093/index.html	An expenditure by or on behalf of a health-care facility in excess of $5.8 million, or some greater amount which has been designated by the Board following an annual adjustment for inflation using an annual inflation index determined by the United States Department of Labor, Bureau of Labor Statistics, which is a capit...	Delaware	16 Del. C. §9304	https://referencesource.org/con-capital-expenditure-thresholds-by-state/delaware/	[ "hospital_capital_threshold", "non_hospital_capital_threshold", "reviewing_agency" ]	null	null
active	[ "con_program_status", "covered_services", "repeal_date", "state", "statutory_citation" ]	$6 million or more	district-of-columbia	$3.5 million in connection with a health service or health facility	N/A	State Health Planning and Development Agency (SHPDA)	https://dchealth.dc.gov/service/certificate-need	Make a capital expenditure of $6 million or more in connection with a hospital and $3.5 million in connection with a health service or health facility.	District of Columbia	DC Official Code 44-401 et seq. (Health Services Planning Program Reestablishment Act of 1996, as amended); Certificate of Need Regulations, Title 22B, DC Municipal Regulations, Sec. 4000 et seq.	https://referencesource.org/con-capital-expenditure-thresholds-by-state/district-of-columbia/	[ "bed_change_trigger", "hospital_capital_threshold", "non_hospital_capital_threshold", "reviewing_agency" ]	Redistribute the beds of a health care facility by 10 beds or 10 percent, whichever is less, in any two-year period.	new health care facility, health care service or home health agency; major medical equipment ($3.5 million by a hospital, $2 million by a healthcare facility, or a single diagnostic/therapeutic device over $350,000); relocation of beds; new health services not offered in the previous 12 months; renal dialysis stations;...
active	[ "con_program_status", "repeal_date", "state", "statutory_citation" ]	$4,000,000 for capital expenditures	hawaii	$4,000,000 for capital expenditures, $1,000,000 for new or replacement medical equipment and $400,000 for used medical equipment	N/A	state health planning and development agency	https://www.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0323D/HRS_0323D-0002.htm	"Expenditure minimum" means $4,000,000 for capital expenditures, $1,000,000 for new or replacement medical equipment and $400,000 for used medical equipment.	Hawaii	Haw. Rev. Stat. §323D-2	https://referencesource.org/con-capital-expenditure-thresholds-by-state/hawaii/	[ "hospital_capital_threshold", "non_hospital_capital_threshold", "reviewing_agency" ]	null	null
active	[ "con_program_status", "repeal_date", "state", "statutory_citation" ]	in excess of one million five hundred thousand dollars within a twelve-month period	iowa	in excess of one million five hundred thousand dollars within a twelve-month period; new services costing over five hundred thousand dollars are separately reviewable	N/A	null	https://www.legis.iowa.gov/docs/code/135.61.pdf	Any capital expenditure, lease, or donation by or on behalf of an institutional health facility in excess of one million five hundred thousand dollars within a twelve-month period.	Iowa	Iowa Code §135.61(16)(c)	https://referencesource.org/con-capital-expenditure-thresholds-by-state/iowa/	[ "bed_change_trigger", "hospital_capital_threshold", "non_hospital_capital_threshold" ]	a permanent change in the bed capacity, as determined by the department, of an institutional health facility	null
active	[ "con_program_status", "repeal_date", "state", "statutory_citation" ]	any capital expenditure of $10,000,000 or more (adjusted annually for medical-care inflation)	maine	capital expenditures of $5,000,000 or more for nursing facilities; more than $5,000,000 (or more than $3,000,000 in specified cases) for ambulatory surgical facilities	N/A	null	https://legislature.maine.gov/statutes/22/title22sec329.html	the obligation by or on behalf of a new or existing health care facility of any capital expenditure of $10,000,000 or more.	Maine	22 M.R.S. §329	https://referencesource.org/con-capital-expenditure-thresholds-by-state/maine/	[ "hospital_capital_threshold", "non_hospital_capital_threshold" ]	null	null
active	[ "con_program_status", "covered_services", "repeal_date", "state", "statutory_citation" ]	the lesser of 25% of the hospital's gross regulated charges for the immediately preceding year or $50,000,000	maryland	N/A — non-hospital CON is triggered by bed capacity changes or new medical services, not a dollar threshold	N/A	Maryland Health Care Commission	https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg&section=19-120	Hospital capital threshold” means the lesser of: (i) 25% of the hospital’s gross regulated charges for the immediately preceding year; or (ii) $50,000,000.	Maryland	Md. Code, Health-General §19-120	https://referencesource.org/con-capital-expenditure-thresholds-by-state/maryland/	[ "hospital_capital_threshold" ]	for non-hospitals, increase or decrease exceeding the lesser of 10% of total bed capacity or 10 beds in a 2-year period; for hospitals, changes in bed capacity require CON with exceptions for transfers within merged asset systems	cardiac surgery, organ transplant surgery, burn or neonatal intensive care, home health, hospice, freestanding ambulatory surgical centers
active	[ "con_program_status", "repeal_date", "state", "statutory_citation" ]	one million dollars in the case of capital expenditures, excluding major medical equipment, and one million dollars in the case of medical equipment	missouri	for long-term care beds, six hundred thousand dollars in the case of capital expenditures, or four hundred thousand dollars in the case of major medical equipment	N/A	Missouri Health Facilities Review Committee	https://www.revisor.mo.gov/main/OneSection.aspx?section=197.305	(c) For health care facilities, new institutional health services or beds not described in paragraph (a) or (b) of this subdivision one million dollars in the case of capital expenditures, excluding major medical equipment, and one million dollars in the case of medical equipment;	Missouri	RSMo §197.305	https://referencesource.org/con-capital-expenditure-thresholds-by-state/missouri/	[ "hospital_capital_threshold", "non_hospital_capital_threshold", "reviewing_agency" ]	null	null
active	[ "con_program_status", "repeal_date", "state", "statutory_citation" ]	a capital expenditure exceeding four million dollars ($4,000,000)	north-carolina	a capital expenditure exceeding four million dollars ($4,000,000); major medical equipment costing more than two million dollars ($2,000,000) is separately reviewable	N/A	null	https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_131E/GS_131E-176.html	the obligation by any person of a capital expenditure exceeding four million dollars ($4,000,000) to develop or expand a health service or a health service facility, or which relates to the provision of a health service.	North Carolina	N.C. Gen. Stat. §131E-176(16)b	https://referencesource.org/con-capital-expenditure-thresholds-by-state/north-carolina/	[ "hospital_capital_threshold", "non_hospital_capital_threshold" ]	null	null
active	[ "con_program_status", "repeal_date", "state", "statutory_citation" ]	in excess of five million two hundred fifty thousand dollars ($5,250,000), adjusted annually by CPI-U	rhode-island	in excess of five million two hundred fifty thousand dollars ($5,250,000); new healthcare equipment with capital costs exceeding $2,250,000 is separately reviewable	N/A	Rhode Island state department of health	https://webserver.rilegislature.gov/Statutes/TITLE23/23-15/23-15-2.htm	Any expenditure, except acquisitions of an existing healthcare facility, that will not result in a change in the services or bed capacity of the healthcare facility by, or on behalf of, an existing healthcare facility in excess of five million two hundred fifty thousand dollars ($5,250,000) which is a capital expenditu...	Rhode Island	R.I. Gen. Laws §23-15-2(10)	https://referencesource.org/con-capital-expenditure-thresholds-by-state/rhode-island/	[ "bed_change_trigger", "hospital_capital_threshold", "non_hospital_capital_threshold", "reviewing_agency" ]	any capital expenditure that results in the addition of a health service or that changes the bed capacity of a healthcare facility; nursing facility bed increases up to the greater of ten beds or ten percent of licensed capacity may be exempted	null
limited	[ "con_program_status", "repeal_date", "state", "statutory_citation" ]	N/A — following 2023 Act No. 20, Certificate of Need requirements apply only to nursing homes	south-carolina	for nursing homes, in excess of an amount to be prescribed by regulation	N/A	null	https://www.scstatehouse.gov/code/t44c007.php	(2) a change in the existing bed complement of a nursing home through the addition of one or more beds or change in the classification of licensure of one or more beds; (3) an expenditure by or on behalf of a nursing home in excess of an amount to be prescribed by regulation which, under generally acceptable accounting...	South Carolina	S.C. Code §44-7-160	https://referencesource.org/con-capital-expenditure-thresholds-by-state/south-carolina/	[ "bed_change_trigger", "hospital_capital_threshold", "non_hospital_capital_threshold" ]	a change in the existing bed complement of a nursing home through the addition of one or more beds or change in the classification of licensure of one or more beds	null
active	[ "con_program_status", "repeal_date", "state", "statutory_citation" ]	no general dollar threshold for general hospitals — projects such as new facilities, bed additions, and specified services are reviewable by category under the Certificate of Public Need law	virginia	any capital expenditure of $15 million or more by or on behalf of a medical care facility other than a general hospital (revised annually for inflation)	N/A	null	https://law.lis.virginia.gov/vacode/32.1-102.1:3/	Any capital expenditure of $15 million or more, not defined as reviewable in subdivisions 1 through 7, by or on behalf of a medical care facility described in subsection A other than a general hospital.	Virginia	Va. Code §32.1-102.1:3(B)(8)	https://referencesource.org/con-capital-expenditure-thresholds-by-state/virginia/	[ "hospital_capital_threshold", "non_hospital_capital_threshold" ]	null	null
active	[ "con_program_status", "repeal_date", "state", "statutory_citation" ]	no dollar threshold — hospital certificate of need review is triggered by construction of new facilities, changes in bed capacity, and new tertiary health services rather than by a capital expenditure amount	washington	for nursing homes, $1,000,000 adjusted by the department by rule	N/A	Washington State Department of Health	https://app.leg.wa.gov/rcw/default.aspx?cite=70.38.025	(5) "Expenditure minimum" means, for the purposes of the certificate of need program, $1,000,000 adjusted by the department by rule to reflect changes in the United States department of commerce composite construction cost index; or a lesser amount required by federal law and established by the department by rule.	Washington	RCW 70.38.105; RCW 70.38.025(5)	https://referencesource.org/con-capital-expenditure-thresholds-by-state/washington/	[ "hospital_capital_threshold", "non_hospital_capital_threshold", "reviewing_agency" ]	null	null
active	[ "con_program_status", "repeal_date", "state", "statutory_citation" ]	at and above $100 million	west-virginia	at and above $100 million	N/A	West Virginia Health Care Authority	https://code.wvlegislature.gov/16-2D-2/	"Expenditure minimum" means the cost of acquisition, improvement, expansion of any facility, equipment, or services including the cost of any studies, surveys, designs, plans, working drawings, specifications and other activities, including staff effort and consulting at and above $100 million;	West Virginia	W. Va. Code §16-2D-2(15)	https://referencesource.org/con-capital-expenditure-thresholds-by-state/west-virginia/	[ "hospital_capital_threshold", "non_hospital_capital_threshold", "reviewing_agency" ]	null	null

Certificate of Need capital expenditure thresholds by US state — dollar thresholds by facility type, covered services, reviewing agencies, and program status

Canonical, always-current version: https://referencesource.org/con-capital-expenditure-thresholds-by-state/ Machine-readable: https://referencesource.org/con-capital-expenditure-thresholds-by-state/data.json — this mirror is a point-in-time copy.

Last verified: 2026-08-19
Stale after: 2027-08-19 (past this date, prefer the canonical copy — it re-verifies on a cadence this snapshot does not)
Records: 13

State-by-state comparison of Certificate of Need (CON) program requirements for healthcare facilities. Each record is one state with whether it has a CON program (and repeal date if not), the capital expenditure threshold that triggers CON review for hospitals and for non-hospital facilities, whether bed capacity changes trigger review (and at what level), the reviewing agency, and the statutory citation. Thresholds range from $1.5 million (Iowa) to $50 million (Maryland) for hospitals. About 35 states plus DC have CON programs; ~15 states have repealed them. Answers 'does my hospital expansion need a Certificate of Need', 'what is the CON threshold for an ASC in [state]', and 'which states have eliminated CON requirements'.

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