Certificate-of-need laws, once pitched as a method for preventing the duplication of healthcare services, have become highly controversial as their opponents cite them as a factor contributing to soaring healthcare costs.
CON laws vary significantly from state-to-state, with different requirements across specialties and practice settings. A briefing paper published Aug. 11 by the Cato Institute, a libertarian think tank, analyzed nearly 130 studies covering CON, including what those laws actually do to access, cost and quality.
Here is a breakdown of services and technologies that have the most widespread CON laws across the U.S., according to the briefing:
| Service or technology | Number of states that require a CON |
|---|---|
| Nursing home beds/long-term care beds | 34 |
| Psychiatric services | 31 |
| New hospitals or hospital-sized investments | 29 |
| Intermediate care facilities for individuals with intellectual disabilities | 28 |
| Hospital beds (acute, general, medical-surgical, etc.) | 27 |
| Long-term acute care | 25 |
| Ambulatory surgical centers | 24 |
| Cardiac catheterization | 24 |
| Rehabilitation | 24 |
| Substance/drug abuse | 24 |
| Open-heart surgery | 22 |
| Radiation therapy | 21 |
| MRI scanners | 20 |
| PET scanners | 19 |
| Neonatal intensive care | 18 |
| Organ transplants | 18 |
| Home health | 17 |
| Obstetrics services | 16 |
| CT scanners | 15 |
| Hospice | 15 |
| Linear accelerator radiology | 15 |
| Mobile hi technology (CT, MRI, PET, etc.) | 15 |
| Renal failure/dialysis | 13 |
| Assisted living and residential care facilities | 10 |
| Burn care | 10 |
| Swing beds | 10 |
| Birth centers | 9 |
| Lithotripsy | 9 |
| Gamma knives | 8 |
| Ground ambulance | 8 |
| Air ambulance | 6 |
| Ultrasound | 2 |
| Subacute services | 1 |
Source: Mitchell et al., February 2021 (via Cato Institute, “Certificate of Need: The Regulation Blocking Greater Access to Higher-Quality and Lower-Cost Care”)
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