North Dakota Certificate of Need Laws
North Dakota
Mostly Free
Year Enacted
—
Services Regulated
—
National Rank
14 of 51
Top Systems
- Sanford Health
- CHI St. Alexius
Reform Status
Mostly Free with no active reform bill.
Key Case
No major case law on record.
North Dakota maintains a very limited Certificate of Need program, creating a mostly free market for healthcare services. This minimal regulatory environment has resulted in one of the least restrictive states in the nation.
4 Services Held Hostage
- ✓Hospitals
- ✓Ambulatory Surgery Centers (ASCs)
- ✓Nursing Homes / Long-Term Care
- ✓Imaging (MRI, CT, PET)
The Permission Process
Source materials include state legislative documents, reports from the Mercatus Center, and public filings from health systems. All data as of latest update.
The North Dakota Healthcare Cartel
Reform Status: Mostly Free
North Dakota has effectively achieved full repeal for most of the healthcare economy. The remaining CON laws for long-term care facilities face little political opposition, as they are seen as a tool for managing capacity in a specialized sector. There is no significant legislative push for further changes.
Data sourced from state agencies, Cicero Institute, and public records.
Last updated: April 2026