Tennessee Certificate of Need Laws
Tennessee
Highly Restrictive
Year Enacted
—
Services Regulated
—
National Rank
36 of 51
Top Systems
- HCA Healthcare
- Ascension Saint Thomas
- Ballad Health
Reform Status
States That Repealed CON
Key Case
No major case law on record.
Nashville, the nation's healthcare capital, is home to HCA Healthcare, the world's largest for-profit hospital operator, whose $60B+ empire benefits directly from CON's anti-competitive barriers.
5 Services Held Hostage
- ✓Hospitals
- ✓Nursing Homes / Long-Term Care
- ✓Home Health Agencies
- ✓Imaging (MRI, CT, PET)
- ✓Major Medical Equipment
The Permission Process
The Health Services and Development Agency (HSDA) administers the CON program, a process often criticized for favoring established players.
Tennessee's CON laws create a protected market for incumbent hospital systems, limiting patient choice and inflating costs.
Tennessee maintains one of the most comprehensive and restrictive CON programs in the United States. The law covers a wide array of services and equipment, making it difficult for new providers to enter the market or for existing providers to expand services without state approval.
Despite the clear market distortions, legislative efforts to significantly reform or repeal CON laws have consistently failed. The powerful lobbying influence of incumbent hospital systems, particularly HCA, presents a formidable barrier to meaningful change. Minor tweaks have occurred, but the core structure remains intact.
How incumbent industries manipulate government regulation to stifle competition.
3 Systems. One Market.
Major academic medical center with significant market share.
States That Repealed CON
Governor: Bill Lee (R)
States That Repealed CON
Data sourced from state statutes, reports from the Mercatus Center, and the National Conference of State Legislatures.
Last updated: April 2026