The policy debate surrounding certificate-of-need laws heated up in 2025, as critics claim the laws have long-stifled competition in healthcare, particularly in the ASC space.
Here are three states where CON laws have shifted in 2025:
Alabama:
Alabama state Sen. Larry Stutts announced plans to file legislation to reform the state’s CON laws in August. He argues that the current process is overly costly and burdensome, and says he has been working with healthcare groups to craft reform proposals.
New York:
In February, New York proposed raising capital expenditure thresholds in its CON process. Under the proposal, the threshold for general hospitals would increase from $15 million to $30 million, and for ASCs and clinics from $6 million to $8 million. The change is aimed at reducing regulatory burdens and modernizing cost benchmarks.
North Carolina
A North Carolina trial court upheld the constitutionality of the state’s certificate-of-need laws, rejecting an ophthalmologist’s years-long legal challenge seeking to overturn it.
Jay Singleton, MD, owner of Singleton Vision Center in New Bern, N.C., originally filed a lawsuit in April 2020. The judges ultimately rejected his legal argument that CON laws provide a monopoly and “exclusive emolument” to incumbent healthcare providers.
Derek Hunter, the state specialty deputy attorney, said that the CON law does not block Dr. Singleton from performing procedures due to a loophole that differentiates an operating room from a “procedure room.” While surgeons need a CON to open an operating room, the law does not apply to a “procedure room,” Mr. Hunter contends, allowing Dr. Singleton to perform as many procedures as he’d like.
Dr. Singleton’s attorney labeled this as an “11th hour argument,” according to the report, the acceptance of which would prevent North Carolina judges from addressing the issue of whether CON violates the state’s constitutional ban on monopolies.
