Summary of the Certificate of Need (CON) Process

The following narrative provides a brief summary of the CON process. Applicants and other interested people should always refer to the applicable statute (G.S. 131E, Article 9, 175-190) (PDF, 97 KB) and administrative rules (10A NCAC Subchapter 14C, PDF, 334 KB) for more complete information.

  1. Allocation of Beds and Services -- At the beginning of each calendar year, a new State Medical Facilities Plan is published by the Medical Facilities Planning Section of DHSR which sets forth the maximum number of health service facility beds, by category, operating rooms, home health offices, and other services that may be approved by the Certificate of Need (CON) Section.
  2. Review Schedule -- In order for competitive applications to be reviewed at the same time, the CON Section has adopted a system to review applications according to a batched review schedule. Under this system, applications for similar services in the same geographic area are reviewed at the same time. Review schedules are found in the State Medical Facilities Plan.
  3. Pre-Application Procedure -- Each applicant submitting an application must submit a letter of intent (LOI) to the CON Section no later than the date the application is due. Most applicants submit an LOI as the first step in the application process. In response to an LOI submitted before the beginning of the review period, the CON Section forwards a letter to the applicant that indicates whether a CON review is required. If so, the CON Section explains the category in which the application will be reviewed, provides the beginning review dates for that category and provides the necessary application forms. An applicant may meet with representatives of the CON Section for a pre-application conference to discuss any questions relative to the CON process and application forms.
  4. Application Submittal -- Applications must be received by 5:30 p.m. on the fifteenth day of the month immediately preceding the beginning of the applicable review period. In instances when the 15th day of the month falls on a weekend or holiday, the filing deadline is 5:30 p.m. on the next business day. The filing deadline is absolute. After an application is submitted it may not be amended, however, the CON Section may request that an applicant submit clarifying information. The CON Section reviews each application to determine if it is complete. An application is deemed complete if the correct fee is paid and the original signature page is provided. If an application is deemed incomplete, within five days the CON Section will notify the applicant of the items needed to make the application complete.
  5. Public Comment Period -- During the first 30 days of the review period, any person may file written comments or letters of support concerning the proposals under review.
  6. Public Hearing -- A public hearing is no longer required to be conducted for each proposal under review. However, under certain circumstances as set forth in G.S. 131E-185(a1)(2) (PDF, 14 KB), a public hearing is required to be conducted by the CON Section in the service area affected by the application no more than 20 days from the conclusion of the written comment period.
  7. Application Review -- The CON Section has from 90 to 150 days to review an application for a certificate of need. Each application is reviewed against G.S. 131E-183 Review criteria (PDF, 18 KB) and any applicable criteria and standards in the administrative rules. All written comments and presentations at the public hearing are also taken into consideration by the CON Section during the review of an application. An application must be conforming or conditionally conforming with all applicable criteria and standards in order to be approved.
  8. Appeals of Decision -- Within 30 days after the date of a decision any affected person may file a petition for a contested case hearing with the Office of Administrative Hearings (OAH). The administrative law judge must make his recommended decision to the director of the Division of Health Service Regulation within 270 days after the petition is filed. The director then makes the final agency decision, which may be appealed to the N.C. Court of Appeals.
  9. Monitoring -- After the certificate is issued, the CON Section will monitor the development of the project through review of progress reports submitted by the applicant. In accordance with G.S. 131E-189 (PDF, 11 KB), the CON Section may withdraw a certificate if the holder of the certificate fails to develop and operate the service consistent with the representations made in the application or with any conditions the CON Section placed on the certificate of need.