Several states are evaluating changes to their certificate-of-need laws and they look to balance the development and expansion of new healthcare services while avoiding repeated services and managing costs for patients.
Here are three states with active proposals to change their CON laws:
1. Companion bills in the Maryland Senate and House propose removing an exception to the state’s certificate-of-need laws. Under the bills, healthcare facility mergers would require a CON or Maryland Health Care Commission approval. Previously, those mergers could qualify for an exemption. The bills propose requiring healthcare entities to provide a 90-day notice to the commission before completing any merger, acquisition or material transaction.
2. The state of Tennessee is currently on track to repeal its 50-year-old certificate-of-need laws by Dec. 1, 2027, a move that will reverberate throughout the state’s healthcare ecosystem.
3. North Carolina’s CON repeal efforts have been paused amid ongoing legal challenges: North Carolina had originally planned to repeal its CON laws by the end of 2025, but a recent court ruling has halted those plans.
On Dec. 12, 2025, a North Carolina trial court upheld the constitutionality of the state’s CON laws, rejecting a years-long legal challenge arguing that the regulations create monopolies for incumbent providers. While broader repeal remains uncertain, the state continues to operate under an interim policy implemented Nov. 1, 2023, exempting ASCs in counties with populations over 125,000 from CON approval.
