Certificate of Need

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A Certificate of Need (CON), in the United States, is a legal document issued by a federal or state regulatory agency with authority over an area which affirms that a proposed acquisition, expansion, or creation of a facility falling under that authority is required to fulfill the needs of a community. The concept of the Certificate of Need first arose in the field of health care. Such a Certificate is now generally necessary for the construction of a medical facility, to be issued by the responsible state health care agency:

The certificate-of-need requirement was originally based on state law. New York passed the first certificate-of-need law in 1964, the Metcalf- McCloskey Act. From that time to the passage of Section 1122 of the Social Security Act in 1972, another 18 states passed certificate-of-need legislation. Section 1122 was enacted because many states resisted any form of regulation dealing with health facilities and services.^[1]

A number of factors spurred states to require certificates of need in the health care industry. Chief among these was the concern that the construction of excess hospital capacity would cause competitors in an oversaturated field to cover the costs of a diluted patient pool by over-charging, or by convincing patients to accept hospitalization unnecessarily.^[2]

In some instances where state and federal authorities overlap, federal regulations may permit that a federal agency to rely on the determination of a state agency with concurrent authority as to the issuance of a certificate of need. However, such reliance is not required. For example, the Department of Housing and Urban Development has issued the following determination:

HUD conducts the same analysis of need whether or not the state has a CON process. There is wide variation in the methods CON states use to decide whether or not to issue a certificate. HUD believes that the Act's required need assessment is best performed using a method that is applied consistently to hospitals in all states. Should the state's CON process and HUD's assessment of need reach differing conclusions on the need for a proposed project, HUD will review the case closely to determine if its conclusion should be changed.^[3]

[edit] References

[edit] Further reading

• Robert James Cimasi, The U.S. Healthcare Certificate of Need Sourcebook (2005). "A state-by-state analysis of the certificate of need statutes, regulations, case law, and key state health department personnel".