Virginia Certificate of Need Laws
Virginia
Most Restrictive
Year Enacted
1973
Services Regulated
19
National Rank
43 of 51
Top Systems
- Sentara Health$13B
- Inova Health System$6.5B
- UVA Health System$5.6B
Reform Status
Current State: No Meaningful Reform
Key Case
No major case law on record.
Services Requiring CON Approval
3 Services Behind the Gate
- ✓Hospitals
- ✓Ambulatory Surgery Centers (ASCs)
- ✓Imaging (MRI, CT, PET)
3 Systems. One Market.
Insurer Dominance
- Top Insurer Market Share
A few large systems control the majority of hospital revenue in Virginia, a sign of a concentrated market.
Current State: No Meaningful Reform
Current State: No Meaningful Reform
Despite numerous attempts, Virginia's COPN law remains largely intact. Bills to repeal or significantly reform the law have consistently failed in the General Assembly, often due to strong opposition from the hospital lobby.
States That Reformed
States that have repealed their CON laws have seen increases in healthcare availability, particularly in rural areas, and lower costs. For example, after repealing its CON law, New Hampshire saw a significant increase in the number of ambulatory surgery centers.
Data sourced from the Virginia Department of Health, Centers for Medicare & Medicaid Services (CMS), Mercatus Center, and the Institute for Justice.
Last updated: April 2026