Repeal Certificate of Need Laws
Senate Bill 370 would repeal North Carolina’s Certificate of Need (CON) laws, which currently require state review and approval before certain health care facilities and services can be developed, expanded, or modified. The bill removes Article 9 of Chapter 131E, the core CON statute, and makes conforming changes across multiple chapters of the General Statutes to eliminate references to CON-based review, definitions, and procedures. It also updates related provisions governing hospitals, home health agencies, adult care homes, hospice, ambulatory surgical facilities, and other health care entities so that those laws no longer depend on CON status.
The bill also revises several administrative and judicial provisions tied to health care regulation and state agency review, including attorney’s fees in contested cases, direct appeals from certain agency decisions, and emergency hospital capacity rules. Most provisions take effect January 1, 2026, and the bill specifies that the repeal applies prospectively to preserve a transition period before the new framework begins.
If enacted, the bill would substantially change state health care facility regulation by removing the certificate of need process from North Carolina law. That would affect hospitals, ambulatory surgical facilities, nursing homes, hospice providers, home health agencies, adult care homes, and other licensed health care providers that currently must navigate CON review for certain projects or services. The repeal would also eliminate several statutory cross-references and related administrative provisions in Chapters 58, 90, 113A, 122C, 131D, 131E, 143B, and 150B, shifting the legal landscape for facility expansion, service changes, and regulatory appeals.
The available voting history suggests the bill drew meaningful support but also notable opposition. It passed second reading in the Senate 31-17, indicating a clear majority in favor but not broad bipartisan consensus. The bill title and structure suggest a deregulatory approach aimed at expanding health care competition and reducing state barriers to entry, which is typically supported by proponents of market-based health policy. No committee transcript is available, so the discussion record does not show detailed stakeholder testimony or amendments.
The central point of contention is the repeal of Certificate of Need regulation itself. Supporters are likely to view CON laws as unnecessary barriers that limit competition, raise costs, and slow the development of new facilities and services. Opponents are likely to argue that CON review helps prevent overbuilding, protects access to essential services in rural or underserved areas, and preserves coordinated planning for major health care investments. Secondary issues include the bill’s broad conforming changes across multiple statutes and the potential effects on hospitals, long-term care, behavioral health, and other regulated providers.