============================================================================== CERTIFICATE OF NEED INTELLIGENCE BRIEF: NEW YORK The Rojas Report | conlaws.rojasreport.com/states/new-york/ ============================================================================== State: New York (NY) Score: 65/100 Tier: Restrictive Rank: 27 of 51 jurisdictions ------------------------------------------------------------------------------ KEY METRICS ------------------------------------------------------------------------------ 8+ Service categories regulated 1964 Year CON enacted 44.2% Kaleida Health market share (Erie Co.) 31.1% Northwell Health market share (Long Island) ------------------------------------------------------------------------------ SUMMARY ------------------------------------------------------------------------------ New York CON score 90/100 (most restrictive). Oldest CON program in the US (1964). Northwell Health holds 31.1% market share on Long Island. ------------------------------------------------------------------------------ SCOPE OF REGULATION ------------------------------------------------------------------------------ * Services Requiring CON Approval * 8+ service categories regulated * Hospital Beds * More beds in rural areas ------------------------------------------------------------------------------ APPLICATION PROCESS ------------------------------------------------------------------------------ New York's CON program, the oldest in the nation, has been in place since 1964. It regulates a broad range of services, creating significant barriers to entry. In major markets like Long Island, incumbent systems like Northwell Health face little meaningful competition. Manhattan ASC Application ------------------------------------------------------------------------------ MARKET CONCENTRATION ------------------------------------------------------------------------------ New York's CON program, the oldest in the nation, has been in place since 1964. It regulates a broad range of services, creating significant barriers to entry. In major markets like Long Island, incumbent systems like Northwell Health face little meaningful competition. Three massive non-profit systems—Northwell, NYU Langone, and NewYork- Presbyterian—dominate the state, collectively pulling in over $46 billion in annual revenue. ------------------------------------------------------------------------------ REFORM STATUS ------------------------------------------------------------------------------ Three massive non-profit systems—Northwell, NYU Langone, and NewYork- Presbyterian—dominate the state, collectively pulling in over $46 billion in annual revenue. New York (No Meaningful Reform) ------------------------------------------------------------------------------ CASE LAW / DENIALS ------------------------------------------------------------------------------ This case is a clear example of how New York's CON process is used to protect existing hospitals from competition. By denying the ASC, the state ensured that patients would continue to have fewer choices and be forced to seek care in higher-cost hospital settings, benefiting the incumbent systems. ============================================================================== Source: The Rojas Report | conlaws.rojasreport.com/states/new-york/ Data: Cicero Institute, NASHP, FTC, DOJ, CMS, state health departments Generated: April 2026 ==============================================================================