============================================================================== CERTIFICATE OF NEED INTELLIGENCE BRIEF: FLORIDA The Rojas Report | conlaws.rojasreport.com/states/florida/ ============================================================================== State: Florida (FL) Score: 5/100 Tier: Mostly Free Rank: 14 of 51 jurisdictions ------------------------------------------------------------------------------ KEY METRICS ------------------------------------------------------------------------------ 3 Services regulated by CON 2019 Year CON partially repealed $17.3B AdventHealth Revenue 36% BCBSFL Market Share ------------------------------------------------------------------------------ SUMMARY ------------------------------------------------------------------------------ Florida CON score 5/100 (mostly free). CON remains for nursing homes/hospice. AdventHealth and HCA dominate key markets. ------------------------------------------------------------------------------ SCOPE OF REGULATION ------------------------------------------------------------------------------ * Services Requiring CON Approval * Sarasota County Hospice Denial * single monopoly hospice provider * nursing homes and hospices ------------------------------------------------------------------------------ APPLICATION PROCESS ------------------------------------------------------------------------------ Florida partially repealed its CON laws in 2019, eliminating them for general hospitals. However, CON requirements remain for nursing homes, hospices, and intermediate care facilities, protecting incumbent providers in the post-acute care sector. The process for remaining CON services is rigorous. Any 'substantially affected person,' including existing providers, can request an administrative hearing to object to a new competitor's application, creating significant barriers to entry. ------------------------------------------------------------------------------ MARKET CONCENTRATION ------------------------------------------------------------------------------ Orlando Area Hospital Market Share (Illustrative) AdventHealth and Orlando Health are the two dominant players in Central Florida. While hospital CON is gone, their scale gives them immense leverage in the remaining regulated services like hospice and nursing homes. ------------------------------------------------------------------------------ REFORM STATUS ------------------------------------------------------------------------------ Florida partially repealed its CON laws in 2019, eliminating them for general hospitals. However, CON requirements remain for nursing homes, hospices, and intermediate care facilities, protecting incumbent providers in the post-acute care sector. By repealing most of its CON law, Florida took a significant step toward a more competitive hospital market. However, by leaving protections for nursing homes and hospices, the state continues to shield some of the most profitable sectors from competition. ------------------------------------------------------------------------------ CASE LAW / DENIALS ------------------------------------------------------------------------------ Sarasota County Hospice Denial Decided 2018 · Sarasota County, Florida · State Court This case highlights the core flaw of CON laws: they prioritize the financial stability of existing providers over the benefits of market competition. The state actively defended the incumbent's monopoly, forcing residents to rely on a single provider for end-of-life care. ============================================================================== Source: The Rojas Report | conlaws.rojasreport.com/states/florida/ Data: Cicero Institute, NASHP, FTC, DOJ, CMS, state health departments Generated: April 2026 ==============================================================================