Repeal Certificate of Need Laws
House Bill 455 would repeal North Carolina’s Certificate of Need (CON) laws, which currently require state approval for many new or expanded health care facilities and services. The bill repeals Article 9 of Chapter 131E and makes a series of conforming changes across the General Statutes to remove references to CON review, including in provisions governing hospitals, home health agencies, adult care homes, ambulatory surgical facilities, hospice, long-term care insurance definitions, Medicaid reporting, administrative appeals, and emergency hospital capacity rules.
The bill also updates several statutes that currently rely on CON terminology or incorporate CON-based definitions, and it preserves or clarifies certain licensing and emergency authority provisions after CON repeal. Most of the changes are set to take effect on January 1, 2026, with some related attorney-fee and appeal provisions applying to contested cases and appeals arising on or after that date. In practical terms, the bill would shift North Carolina away from a state-controlled certificate-of-need framework and toward a more open market for health care facility development and expansion, while leaving other licensing and regulatory systems in place.
If enacted, H455 would eliminate the legal framework that currently governs certificate-of-need review in North Carolina, removing a major regulatory hurdle for hospitals, ambulatory surgical facilities, home health agencies, hospice providers, adult care homes, and other health care entities. It would also repeal or revise multiple statutes that reference CON review, including provisions in health, insurance, administrative procedure, environmental, and licensing laws, so that those laws continue to function without the repealed article. The bill would therefore materially change how health care capacity and facility expansion are regulated in the state, while preserving separate licensure, emergency, and public-health oversight mechanisms.
The bill title and sponsor lineup indicate a clear pro-repeal, deregulatory posture, and the text is structured to comprehensively dismantle the CON regime rather than modify it. No committee transcripts or recorded votes were provided, so there is no documented floor or committee debate in the supplied materials. Based on the bill’s content alone, the overall sentiment appears strongly supportive of market-based health care expansion among the sponsors, with the measure framed as a broad policy change rather than a narrow technical adjustment.
The main point of contention is the underlying policy choice to repeal certificate-of-need regulation, which historically has been defended as a way to control health care costs, prevent overbuilding, and coordinate facility planning, but criticized as a barrier to competition and access. Health care providers that would benefit from easier entry or expansion are likely to support the bill, while existing hospitals, regulated facility operators, and stakeholders who favor state planning may oppose it. Additional friction may arise over the bill’s many conforming amendments, especially where existing statutes rely on CON concepts to define facilities or limit changes in service lines, because those provisions must be reinterpreted or replaced after repeal.