New York Certificate of Need Laws
New York
Restrictive
Year Enacted
1964
Services Regulated
—
National Rank
27 of 51
Top Systems
- Northwell Health
- NYU Langone Health$14.2B
- NewYork-Presbyterian$13.2B
Reform Status
New York (No Meaningful Reform)
Key Case
No major case law on record.
New York's CON program, the oldest in the nation, has been in place since 1964. It regulates a broad range of services, creating significant barriers to entry. In major markets like Long Island, incumbent systems like Northwell Health face little meaningful competition.
2 Services Behind the Gate
- ✓Hospitals
- ✓Ambulatory Surgery Centers (ASCs)
The Permission Process
In 2013, an application was filed to establish a new multispecialty ambulatory surgery center (ASC) in Manhattan. The goal was to provide a lower-cost, more convenient option for outpatient surgical procedures.
This case is a clear example of how New York's CON process is used to protect existing hospitals from competition. By denying the ASC, the state ensured that patients would continue to have fewer choices and be forced to seek care in higher-cost hospital settings, benefiting the incumbent systems.
4 Systems. One Market.
Insurer Dominance
- With a perfect score of 100, Kentucky has one of the most restrictive CON programs in the United States.
Three massive non-profit systems, Northwell, NYU Langone, and NewYork-Presbyterian, dominate the state, collectively pulling in over $46 billion in annual revenue.
Long Island market share for Northwell: 31.1%
New York (No Meaningful Reform)
New York (No Meaningful Reform)
States That Reformed
States that have repealed or significantly reformed their CON laws have seen increased competition, lower costs, and improved access to care. Evidence from these states shows that markets, not regulators, are better at determining public need.
$18.6 billion in revenue
Data sourced from the New York State Department of Health, the PHHPC, Centers for Medicare & Medicaid Services (CMS), and the Cicero Institute.
Last updated: April 2026