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  CERTIFICATE OF NEED INTELLIGENCE BRIEF: TENNESSEE
  The Rojas Report | conlaws.rojasreport.com/states/tennessee/
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  State:    Tennessee (TN)
  Score:    85/100
  Tier:     Highly Restrictive
  Rank:     36 of 51 jurisdictions

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  SUMMARY
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  In-depth analysis of Tennessee's highly restrictive Certificate of Need
(CON) laws, their market impact, and the dominance of HCA Healthcare.

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  SCOPE OF REGULATION
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  * Regulated Services
  * Regulated Healthcare Services
  * Nursing Homes & Home Health
  * Diagnostic Imaging (MRI, CT, PET)

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  APPLICATION PROCESS
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  Application & Approval

  The Health Services and Development Agency (HSDA) administers the CON
program, a process often criticized for favoring established players.

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  MARKET CONCENTRATION
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  Nashville, the nation's healthcare capital, is home to HCA Healthcare, the
world's largest for-profit hospital operator, whose $60B+ empire benefits
directly from CON's anti-competitive barriers.

  Tennessee's CON laws create a protected market for incumbent hospital
systems, limiting patient choice and inflating costs.

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  REFORM STATUS
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  Governor: Bill Lee (R)

  States That Repealed CON

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  Source: The Rojas Report | conlaws.rojasreport.com/states/tennessee/
  Data: Cicero Institute, NASHP, FTC, DOJ, CMS, state health departments
  Generated: April 2026
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