Arkansas Certificate of Need Laws
Arkansas
Mostly Free
Year Enacted
—
Services Regulated
—
National Rank
18 of 51
Top Systems
- Baptist Health
- Mercy Health
- CHI St. Vincent
Reform Status
Mostly Free with no active reform bill.
Key Case
Case Law: Denial of Home Health Services
Arkansas replaced its broad Certificate of Need (CON) program with a narrower Permit of Approval (POA) system in 1987, primarily regulating long-term care and home health services while largely exempting hospitals. This shift has created a unique regulatory landscape that warrants close examination.
6 Services Held Hostage
- ✓Hospitals
- ✓Ambulatory Surgery Centers (ASCs)
- ✓Nursing Homes / Long-Term Care
- ✓Home Health Agencies
- ✓Hospice
- ✓Imaging (MRI, CT, PET)
The Permission Process
The state uses a structured batching system for POA applications, creating predictable but rigid timelines for market entry.
Four 90-day review cycles per year with set deadlines (Feb 1, May 1, Aug 1, Nov 1).
The Health Services Permit Agency must issue a decision within 90 days of the review cycle start.
Crucially, competitors cannot judicially appeal a decision to *grant* a Permit of Approval.
The most significant feature of the modern POA system is the 2001 law (Act 1800) that explicitly bars competitors from seeking judicial review of a granted permit. This creates a one-way street for legal challenges: applicants can sue if denied, but competitors cannot sue if a new rival is approved. This legislative shield effectively nullifies a key accountability mechanism, entrenching the commission's decisions and protecting approved applicants from legal challenges by incumbents.
3 Systems. One Market.
Insurer Dominance
- Insurer Market Share
- The payer side is similarly concentrated, with three major players dominating the state's health insurance market.
- Arkansas BCBS
- UnitedHealth Group
- An overview of how Certificate of Need laws stifle competition across the United States.
Threshold of $1,000,000 for nursing home renovations.
While hospitals are largely exempt from POA, the historical lack of competition has led to highly concentrated markets. The Herfindahl-Hirschman Index (HHI) for these markets would be considered 'highly concentrated' by federal antitrust agencies.
Case Law: Denial of Home Health Services
Case Law: Denial of Home Health Services
Data sourced from public records, state statutes, and agency reports. Market share data from the American Medical Association and National Association of Insurance Commissioners.
Last updated: April 2026