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.
However, the current standing law continues to complicate efforts to improve rural health access in the state, according to a Jan. 16 viewpoint published in The Tennessean.
For example, the op-ed notes that Congress recently passed the Rural Healthcare Transformation Program, which awarded $50 billion across all 50 states from 2026 through 2030.
The first-year funding was announced Dec. 29, with each state receiving at least $147 million. Texas leads the allocations with $289.3 million. However, the money is not guaranteed, the authors write, and each state must apply for a grant.
“Each application is scored not only by need, but also on whether the state enforces anticompetitive laws in healthcare,” they wrote. “Chief among these bad policies are certificate-of-need laws.”
CON laws have come under scrutiny from policy makers and healthcare stakeholders in recent years. Opponents to the laws argue that CON applications are often shut down by incumbent organizations looking to quell potential competition, leading to higher healthcare costs and decreased access for patients.
In Tennessee, lawmakers have affirmed their intentions to follow through with the repeal of CON. Rep. Greg Vital, a Republican from Harrison, said that the “[CON] process has become nothing more than a free gratification,” in a recent report by the Chattanooga Times Free Press.
For example, Parkview Medical Center, an affiliate of HCA Healthcare — one of the largest ASC operators in the country — has faced criticism over its plan to build a freestanding emergency department in Cleveland, Tenn. Vitruvian Health’s Bradley Medical Center has launched an online petition urging residents to oppose the project, arguing the new facility would increase costs, fragment care and create duplicate services in the region. It also said that the new ER would draw patients away from the local nonprofit hospital.
HCA leaders, however, argued that population growth in the area requires more emergency care options.
“The proposed Parkridge Cleveland ER will strengthen emergency care access at a time when this community is growing faster than the system can keep up,” Mr. Cosby said in a statement to Becker’s. “With more than 110,000 residents and thousands of new homes, businesses and commuters coming into the area, relying on a single hospital creates longer waits and fewer options when minutes matter. Adding a second, full-service ER helps relieve that pressure, lowers wait times and adds competition that raises the standard of emergency care for everyone.”
CON laws can be particularly challenging for smaller organizations, who may not have the financial or legal resources to pursue the CON application and legal defense process. CON application fees in Tennessee range from a minimum of $15,000 to a maximum of $95,000, according to the Times Free Press, depending on the scale of the project.
Rob Simmons and Jeff McPherson, CEO and market president of Nashville-based Tennessee Orthopaedic Alliance, respectively, told Becker’s that while the original idea behind CON was reasonable, the laws no longer make as much sense in a healthcare environment drastically different from that of the 1970s.
“At this point, allowing the consumer to have the opportunity to evaluate and choose the best location for their outpatient surgical care, and letting those with a better product to deliver that care, is the best course of action,” they said.
Mr. Simmons and Mr. McPherson also said that repeal would spark healthy competition in the state.
“We have recently completed a new surgery center that was required to go through the CON process. As part of that CON requirement, we were forced to consider political and financial relationships due to the CON process limiting both the timing and project scope of what we wanted to consider,” they added. “Freeing up the ability to build an ASC without a CON will create more access to patients and expand care in a competitive environment allowing the opportunity for more effective, efficient and a higher level of care to the residents of Tennessee.”
