============================================================================== CERTIFICATE OF NEED INTELLIGENCE BRIEF: KENTUCKY The Rojas Report | conlaws.rojasreport.com/states/kentucky/ ============================================================================== State: Kentucky (KY) Score: 100/100 Tier: Most Restrictive Rank: 43 of 51 jurisdictions ------------------------------------------------------------------------------ KEY METRICS ------------------------------------------------------------------------------ 18 Services regulated by CON 1972 Year CON enacted 3,720 Louisville market HHI 354% Max pricing vs. Medicare ------------------------------------------------------------------------------ SUMMARY ------------------------------------------------------------------------------ Kentucky CON score 100/100 (most restrictive). 18 services regulated since 1972. Three systems control 100% of Louisville's inpatient market. Pricing reaches 354% of Medicare. ------------------------------------------------------------------------------ SCOPE OF REGULATION ------------------------------------------------------------------------------ * Services Requiring CON Approval * 9 home health agencies for 22,000 patients ------------------------------------------------------------------------------ APPLICATION PROCESS ------------------------------------------------------------------------------ The process is bifurcated into two tracks. The Formal Review is the most common and complex path. The applicant bears the burden of proving the proposed service is necessary, and a decision is typically rendered six months after the application date. This process resembles a trial, where incumbent providers can intervene to block a new competitor's entry. Hospital mergers have been found to increase the average hospital price by 6-18% nationwide. Kentucky's experience aligns with this trend, as the state's CON laws protect incumbent systems from new entrants that could offer more competitive pricing. ------------------------------------------------------------------------------ MARKET CONCENTRATION ------------------------------------------------------------------------------ Kentucky's CON laws have been in place since 1972. They regulate 18 different services, devices, and procedures. Three hospital systems control 100% of the Louisville inpatient market. Competition is not just difficult here. It is illegal. Three systems control 100% of the inpatient hospital market in Louisville. Norton Healthcare's 55% share gives it a commanding position. ------------------------------------------------------------------------------ REFORM STATUS ------------------------------------------------------------------------------ $2 billion health care conglomerate How a $2 billion conglomerate used CON laws to block a Nepali immigrant from serving refugees. ------------------------------------------------------------------------------ CASE LAW / DENIALS ------------------------------------------------------------------------------ Case Concluded. CON Upheld. The case received unfavorable decisions at both the district court and the Sixth Circuit Court of Appeals (February 2022). The U.S. Supreme Court declined to hear the case in November 2022. Tiwari v. Meier: Full Case Analysis ============================================================================== Source: The Rojas Report | conlaws.rojasreport.com/states/kentucky/ Data: Cicero Institute, NASHP, FTC, DOJ, CMS, state health departments Generated: April 2026 ==============================================================================