Pillar 01

CON Laws

Certificate of need · Market entry · State regulation

LowFAH has said nothing on certificate of need in 2025 or 2026. The barrier is falling state by state without it.

Last verified November 6, 2026

FAH position

No position found. FAH filed no statement, letter, comment or testimony on certificate of need from January 2025 through November 6, 2026. Its May 2025 letter to the FTC and DOJ on anticompetitive regulation does not mention CON.

Where it stands

Status as of November 2026

October 12, 2026Cicero Institute's 2026 ranking: 25 states acted on CON in 2026 sessions. Rhode Island, Iowa and Delaware repealed entire categories. source
June 30, 2026Rhode Island's FY2027 budget act removed behavioral health, ambulatory surgery centers, home care and CT, MRI and PET imaging from CON. The capital threshold rose to $50 million. source
May 5, 2026Tennessee Public Chapter 887 ends CON for new acute care hospitals on July 1, 2030, with TennCare and charity care licensure conditions. Satellite emergency departments and cardiac catheterization phase out by 2028. source
March 5, 2026Iowa HF 2635 repealed CON review for cardiac catheterization, open-heart surgery, organ transplantation, radiation therapy and air ambulance. Cost thresholds rise in steps to $5 million by 2037. source
April 21, 2026Delaware HB 17 repealed certificate of public review for major medical equipment purchases. source
March 31, 2026Maine LD 1890 became law without the governor's signature. It exempts most ambulatory surgery centers and raises the capital threshold from $3 million to $7.5 million, indexed to inflation. source
May 5, 2026The federal lever: CMS's $50 billion Rural Health Transformation Program scores CON repeal with Cicero's nine-category method. HFMA counts 17 states that pledged CON reform in their applications. source
December 11, 2025Entering 2026, Cicero counted 41 states plus DC with some form of CON law. source

FAH on the record

Letters, comments and statements

May 21, 2025FAH's letter to the FTC and DOJ on anticompetitive regulation lists five items. They are noncompetes, 340B eligibility, state mini-HSR acts, the No Surprises Act and the POH ban. Certificate of need is not mentioned. source

The evidence

•Cicero, October 2026: 25 states acted on CON laws in 2026 and three repealed entire categories of review. source
•Tennessee's acute care hospital CON ends July 1, 2030, later than the 2028 date in the bill as introduced. source
•FAH's public comments archive for January 2025 through November 2026 contains no certificate of need letter. source

What it means for physicians

CON is the state-level wall around incumbent hospitals, and the wall is coming down without FAH's help. The fight is in state capitals, where for-profit chains lobby through state associations, not through FAH. For a physician who wants to build, the live map is the Cicero ranking and the Rural Health Transformation Program scoring, not anything FAH says.

Sources