============================================================================== CERTIFICATE OF NEED INTELLIGENCE BRIEF: OKLAHOMA The Rojas Report | conlaws.rojasreport.com/states/oklahoma/ ============================================================================== State: Oklahoma (OK) Score: 20/100 Tier: Mostly Free Rank: 20 of 51 jurisdictions ------------------------------------------------------------------------------ SUMMARY ------------------------------------------------------------------------------ Complete analysis of Oklahoma's Certificate of Need laws. Market concentration data, regulated services, application process, reform history, and the Saint Francis 340B investigation. CON score: 20/100. ------------------------------------------------------------------------------ SCOPE OF REGULATION ------------------------------------------------------------------------------ * Services Regulated * Remaining Regulated Services * Nursing facilities (new construction) * Saint Francis Beds ------------------------------------------------------------------------------ APPLICATION PROCESS ------------------------------------------------------------------------------ Oklahoma's multi-decade CON reform—from the late 1980s hospital deregulation through SB 1388 (2018) and HB 2330 (2024)—has eliminated requirements for hospitals, ASCs, psychiatric facilities, and most acute care. This was real progress. But the remaining regulations in long-term care still create barriers where incumbent nursing homes weaponize the appeals process to block competitors (as documented in the Wood Manor and Hometown Memory Care cases), and the larger issue is that CON reform alone does not address the structural advantages that dominant systems like Saint Francis have accumulated through 340B, tax exemption, and market concentration. ------------------------------------------------------------------------------ MARKET CONCENTRATION ------------------------------------------------------------------------------ Oklahoma State Dept. of Health (OSDH), Health Facility Systems Division Saint Francis dominates with 1,112-bed flagship; 56.2% of OK hospitals in monopoly markets (HHI>5,000) ------------------------------------------------------------------------------ REFORM STATUS ------------------------------------------------------------------------------ The absence of disclosure is not merely an opacity finding. It is the program working exactly as critics have described: a federal subsidy designed for vulnerable patients, warehoused inside a system generating $308M in annual surplus, with no public accounting for where the spread goes. Significant Reform, Incomplete Victory (Updated 2024) ------------------------------------------------------------------------------ CASE LAW / DENIALS ------------------------------------------------------------------------------ Oklahoma's multi-decade CON reform—from the late 1980s hospital deregulation through SB 1388 (2018) and HB 2330 (2024)—has eliminated requirements for hospitals, ASCs, psychiatric facilities, and most acute care. This was real progress. But the remaining regulations in long-term care still create barriers where incumbent nursing homes weaponize the appeals process to block competitors (as documented in the Wood Manor and Hometown Memory Care cases), and the larger issue is that CON reform alone does not address the structural advantages that dominant systems like Saint Francis have accumulated through 340B, tax exemption, and market concentration. ============================================================================== Source: The Rojas Report | conlaws.rojasreport.com/states/oklahoma/ Data: Cicero Institute, NASHP, FTC, DOJ, CMS, state health departments Generated: April 2026 ==============================================================================