Scope of Regulation
What requires a state permission slip?
Regulated Services
Nevada's CON law applies to a broad range of new or expanded health facilities in rural areas, plus specialized services statewide.
- New Hospitals & Clinics in rural areas
- Ambulatory Surgery Centers (ASCs) in rural areas
- Imaging & Dialysis Centers in rural areas
- Any rural project with capital costs over $2,000,000
- New Air Ambulance (Helicopter) Services
The Application Process
| Reviewer | DHHS (shifting to NV Health Authority) |
| Application Fee | $9,500 |
| Review Timeline | ~75-90 days |
| Incumbent Veto? | Competitors can intervene |
Market Concentration
Who benefits from the lack of competition?
Dominant Systems
The hospital market is highly concentrated, with a few large players controlling regional markets.
- Renown Health: Dominates Northern Nevada
- UMC of Southern Nevada: Public giant in Las Vegas
- HCA Healthcare: Major for-profit chain in the south
Insurer Landscape
The commercial insurance market is a duopoly, limiting choices for employers and patients.
The Human Cost
How CON laws block care.
Dept. of Human Resources v. UHS of the Colony (1987)
In a landmark case, the Nevada Supreme Court affirmed the state's power to block a new $2.1 million mobile MRI unit, ruling it was a "health facility" requiring a CON. This decision effectively halted the project and cemented the state's authority to prevent new capital investments in healthcare technology without government approval, a clear example of CON laws restricting access to modern diagnostics.
Reform Status
Where does Nevada stand on CON reform?
Nevada's CON law, enacted in 1971, remains firmly in place with no significant repeals. While administrative oversight is shifting, the core regulatory barriers persist, maintaining a restrictive environment that favors established players.
The Rojas Report Take
With a perfect score of 100, Nevada's Certificate of Need regime stands as one of the most restrictive in the nation. For over half a century, this law has served not the public, but the entrenched interests of hospital monopolies. By setting a $2 million barrier for new projects in rural areas — the very places desperate for more healthcare options — the state has created a government-enforced cartel.
The ability of incumbents like Renown and HCA to legally object to new competitors is not a feature; it's the entire point. This system chokes off innovation, inflates costs, and leaves Nevadans with fewer choices. It's a protectionist racket, plain and simple.
Related Content
The National CON Investigation
Explore our 50-state analysis of Certificate of Need laws.
California Profile
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