Several states are actively reshaping their certificate-of-need regulations, with implications for ASCs. These policy shifts aim to modernize outdated thresholds, ease regulatory burdens and improve access to care.
Here are four key state-level updates to know:
1. Alabama state Sen. Larry Stutts recently announced plans to file a bill during the next legislative session to reform certificate-of-need laws in the state. Mr. Stutts previously filed legislation aimed at limiting the authority of Alabama’s CON Review Board.
He said Alabama’s current CON process is too expensive and burdensome for healthcare providers. He added that he has been working with various healthcare groups to shape the legislation for the upcoming session.
2. North Carolina plans to fully eliminate its certificate-of-need laws by January 2026. This planned repeal signals a major deregulation of healthcare facility development, particularly favorable for the growth of ASCs, imaging centers, and other outpatient services.
In the interim, the state has adopted a phased approach. As of November 1, 2023, ASCs located in counties with populations over 125,000 no longer require CON approval. This transition allows healthcare providers in more populous regions to move ahead with expansion plans while broader repeal efforts continue to unfold statewide.
3. In February 2025, New York State proposed significant amendments to its CON process aimed at easing regulatory burdens and modernizing cost benchmarks. Under the proposal:
The capital expenditure threshold for general hospitals would increase from $15 million to $30 million. For other Article 28 healthcare facilities, such as ASCs and clinics, the threshold would rise from $6 million to $8 million.
These proposed changes reflect inflation and cost-of-construction shifts since the last update in 2017. The goal is to streamline oversight for lower-risk projects and reduce delays for essential facility upgrades and new development.
4. Both Tennessee and Georgia have also advanced reforms to scale back their CON requirements in the past year. Tennessee passed legislation that will scale back its CON program by 2025 through a phased program. Georgia has adopted incremental revisions, including raised spending thresholds and relaxed rules for certain rural projects, although it maintains its overall CON framework for now.
