Certificate of Need (CON)

Many states have Certificate of Need or Certificate of Necessity (CON) laws which are designed to control the growth and associated costs of health care facilities and services, coordinate the planning of health care facilities, and avoid duplication. Although there is an incredibly large degree of variation between jurisdictions, all CON laws require that certain health care providers receive approval before commencing major projects, e.g. building expansions. Some states also allow for a Certificate of Exemption (COE), in lieu of a full CON. Federal law used to require states to have an approval process for health care projects involving major capital outlays but, even with the repeal of that law, 38 states still have some form of CON program.

CON approval is most commonly required for acute care hospital beds, ambulatory surgery centers, nursing homes, open heart surgery, and rehab. Relatively few jurisdictions require approval for assisted living facilities or medical office buildings.

There are a number of factors that can make the CON and COE process difficult. The rules tend to be extremely complex, both from a procedural as well as a substantive standpoint, and applications often require not only regulatory expertise, but financial and medical knowledge as well. Likewise, there is no set formula for obtaining approval. Each project is unique and its ultimate success depends not on filling out the proper forms but on convincing the relevant authority that the project will serve the health care needs of its community. Furthermore, providers operating in multiple jurisdictions would be subject to very different rules, not only as to which types of projects are covered, but also how standards are applied and how the application process is conducted.

Murer Consultants has decades of experience and an impressive track record encompassing multiple states. Murer has never failed to win approval of its clients’ projects. We have cultivated good working relationships with state authorities, which is helpful in ensuring a prompt and fair hearing of our clients’ applications. Moreover, the skill sets necessary to complete CON applications and to argue their merits align with Murer’s particular strengths in regulatory, financial, and medical knowledge. The basis of Murer’s success has been and continues to be its ability to find the uniqueness in every project and to persuade the relevant governing body of its merits, whether it be through the CON application or during a CON hearing. Murer has an extensive expertise in providing expert testimony concerning a CON submission.

We are able to offer a number of services for providers interested in obtaining CON certification. These include:

  • General regulatory guidance;
  • Consultations as to the applicability of CON rules to a particular project;
  • Discussions regarding the applicability and feasibility of a COE;
  • Strategic analyses evaluating likelihood of approval;
  • Interface with state CON authorities;
  • Drafting and submission of applications;
  • Identification and development of a project’s unique value proposition;
  • Preparation for and participation in hearings before state governing bodies; Providing expert testimony; and
  • Post approval implementation of projects.