North Carolina Certificate of Need (CON)

General Information

The North Carolina Certificate of Need (CON) law goes outside of N.C. DHHS. prohibits health care providers from acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances, without the prior approval of the Department of Health and Human Services. Prior approval is also required for the initiation of certain medical services. The law restricts unnecessary increases in health care costs and limits unnecessary health services and facilities based on geographic, demographic and economic considerations.


The fundamental premise of the CON law is that increasing health care costs may be controlled by governmental restrictions on the unnecessary duplication of medical facilities. To accomplish its purpose, the CON law provides that "no person shall offer or develop a new institutional health service without first obtaining a certificate of need." All new hospitals, psychiatric facilities, chemical dependency treatment facilities, nursing home facilities, adult care homes, kidney disease treatment centers, intermediate care facilities for mentally retarded, rehabilitation facilities, home health agencies, hospices, diagnostic centers, and ambulatory surgical facilities must first obtain a CON before initiating development. In addition, a CON is required before any upgrading or expansion of existing health service facilities or services, which involves a capital expenditure above specified minimums.

Administration of the CON law is entrusted to the Department of Health and Human Services. The Certificate of Need Section in the department's Division of Health Service Regulation is responsible for its implementation. Anyone desiring a certificate of need must apply to the CON Section, and furnish information upon which the section can find that the application is consistent with specified "review criteria." The section may approve or deny an application outright, or it may approve the application with such conditions, as it finds necessary to bring the project into compliance with the mandated criteria.

Topics We Follow

Division of Health Service Regulation

The Division of Health Service Regulation oversees medical, mental health and adult care facilities, emergency medical services, and local jails. They check to see that people receiving care in these facilities are safe and receive appropriate care. They make certain that medical buildings are built only when there is a need for them.

Certificate of Need Overview

1. Allocation of Beds and Services
2. Review Schedules
3. Pre-Application Procedure
4. Application Submittal
5. Public Comment Period
6. Public Hearing
7. Application Review
8. Appeals of Decision
9. Monitoring

Contact us for more information.

Recent Letters of CON Exemption (request information)

These letters are posted on a monthly basis in a PDF format on the Agency’s website beginning with letters mailed during January 2012. They should be available on or about the 15th of the following month.

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