Rhode Island Certificate of Need Laws
Rhode Island
Highly Restrictive
Year Enacted
—
Services Regulated
—
National Rank
33 of 51
Top Systems
- Dept. of Health
Reform Status
Highly Restrictive with no active reform bill.
Key Case
Case Study: Encompass Health Denied
Rhode Island's long-standing and expansive Certificate of Need program creates significant barriers to entry, protecting incumbent health systems and limiting consumer choice. The state's healthcare market is highly concentrated, with a few dominant players.
7 Services. One Board. Zero Competition.
- ✓Hospitals
- ✓Ambulatory Surgery Centers (ASCs)
- ✓Nursing Homes / Long-Term Care
- ✓Hospice
- ✓Imaging (MRI, CT, PET)
- ✓Rehabilitation Facilities
- ✓Cardiac / Open Heart Surgery
The Permission Process
In 2021, a proposal by Encompass Health to build a new 50-bed inpatient rehab hospital was overturned on appeal from existing providers. The stated reason was a lack of public need, effectively protecting incumbent hospitals from new competition and forcing patients to rely on existing, potentially overburdened, facilities.
The Rhode Island Healthcare Cartel
Insurer Dominance
- Insurer Market Concentration
- BCBS of Rhode Island dominates the commercial market with a staggering 76% share in the large-group market.
New services with >$1.7M annual operating cost
Lifespan, Care New England, and CharterCARE are the three largest systems, controlling the majority of inpatient volume.
Case Study: Encompass Health Denied
Case Study: Encompass Health Denied
Reform Status: Highly Restrictive
Rhode Island's CON law has been amended over 25 times but never fully repealed. A 2026 bill to repeal the statutes was introduced but has not passed, indicating that significant reform is not on the immediate horizon. The state remains committed to its CON regime, with periodic adjustments rather than a fundamental overhaul.
Data sourced from state agencies, Cicero Institute, and public records.
Last updated: April 2026