1. North Carolina: The state advanced plans to repeal certificate-of-need requirements for ASCs in counties with populations over 125,000 people, effective Nov. 21, 2025. Affected ASCs must meet specific charity care obligations and submit annual data reports to maintain compliance.
Richard Saver, a professor of law at the University of North Carolina Chapel Hill who works in the departments of social medicine, the UNC school of medicine and the UNC Gillings School of Public Health, told Becker’s that the change in CON policy could heat up competition in the state.
“This may vary region by region,” Mr. Saver said. “In highly competitive markets like we have here in the Research Triangle, or in other segments of the state, the major health systems are still going to be competing with each other, and there may be competitive pressures because of that to lower cost to entrance,” should CON be overturned.
2. Tennessee: The state will repeal its CON laws by Dec. 1, 2027, which could encourage ASC development. Once the repeal takes place, independent ASCs will be required to participate in TennCare and provide comparable levels of care to program enrollees and charity care patients, similar to hospital-affiliated ASCs. The Tennessee Health Facilities Commission is also tasked with developing a six-year assessment plan to monitor the impacts of these changes.
Nashville, Tenn.-based HCA Healthcare CFO Mike Marks said in a Jan. 24 earnings call that the removal of CON laws in Tennessee would enable HCA to develop its outpatient network “much more quickly and aggressively.”
3. Georgia: The state also proposed CON reforms that exempt some single-specialty ASCs from CON requirements, if they are owned by a single physician or practice and stay below specific capital expenditure and operating room thresholds. The reforms permit non-owner physicians within the same specialty to operate these ASCs and permit joint ventures with hospitals, including the use of external management. The Georgia Department of Community Health is also expected to dole out more recommendations, which could lead to future policy changes.
4. Illinois: This could be a promising state for gastroenterology practices looking to open or grow, after the state’s governor signed an expansive piece of colonoscopy legislation. Illinois saw at least three new GI practices open or expand in 2024. According to data published by the National Cancer Institute, Illinois’ rates of new CRC cases overall and the number of advanced-stage diagnoses are higher than the U.S. national average.
5. Florida: Florida saw a flurry of new ASCs in 2024, tied with Texas for the most ASC developments, despite having a smaller population. An aging population and high demand for services in the state could point to a promising market for ASCs.
