Certificate-of-need laws, which regulate the development of new healthcare facilities and equipment purchases, continue to evolve across the U.S., reshaping ASC markets.
Here are seven states where CON laws have shifted in the last few years:
Alabama:
Alabama state Sen. Larry Stutts has announced plans to file legislation to reform the state’s CON laws in the upcoming session. He argues that the current process is overly costly and burdensome, and says he has been working with healthcare groups to craft reform proposals.
Georgia:
In 2024, Georgia advanced CON reforms that exempt certain single-specialty ASCs from review if they are owned by a single physician or practice and stay below specified capital expenditure and operating room thresholds.
The reforms also allow non-owner physicians within the same specialty to practice in these centers and permit joint ventures with hospitals, including external management arrangements. The Georgia Department of Community Health is expected to issue additional recommendations that could lead to further policy changes.
Massachusetts:
Massachusetts’ CON law is drawing criticism for restricting access to imaging services.
Lexington-based internist Amy Boutwell, MD, told Valley News on Oct. 11 that she recently had to refer a patient out of state for follow-up imaging because nearby hospitals had a five-month waitlist. The closest independent imaging center she could find was 30 miles away in Nashua, N.H., which had next-day availability and lower costs.
Valley News cited Massachusetts’ CON law as a contributing factor, noting that it requires state approval for new healthcare facilities and major equipment acquisitions, including MRI machines. Critics argue this has limited access to affordable imaging care.
Montana:
Since repealing its CON law in 2021, Montana has seen a 12.5% increase in the number of ASCs, home health agencies, and inpatient addiction treatment centers, according to an October report from the Frontier Institute.
Without CON restrictions, new ASCs can open without state approval or competitor challenges, expanding access to same-day surgical care, particularly in rural areas that previously lacked such options.
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:
North Carolina is on track for a near-total repeal of its CON laws by January 2025.
As an interim measure, since Nov. 1, 2023, ASCs in counties with populations over 125,000 have been exempt from CON approval, already spurring new facility development in high-demand regions.
“This may vary region by region,” said Richard Saver, a professor of law at the University of North Carolina at Chapel Hill who also works in the university’s social medicine, medical, and public health departments. “In highly competitive markets like the Research Triangle or other parts of the state, major health systems will continue to compete with one another. If CON is overturned, it could create competitive pressure to lower barriers to entry.”
Tennessee:
Tennessee plans to repeal its CON laws by Dec. 1, 2027. Once the repeal takes effect, independent ASCs will be required to participate in TennCare and provide care for TennCare enrollees and charity care patients at levels comparable to hospital-affiliated ASCs. The Tennessee Health Facilities Commission will also conduct a six-year assessment to monitor the effects of the repeal.
