Health Care Facility Services   CON    Overview

Overview of Maryland Certificate of Need (CON) Program

The Maryland Certificate of Need (“CON”) program is intended to ensure that new health care facilities and services are developed in Maryland only as needed and that, if determined to be needed, that they are:

  • The most cost-effective approach to meeting identified needs;
  • Of high quality;
  • Geographically and financially accessible;
  • Financially viable; and
  • Will not have a significant negative impact on the cost, quality, or viability of other health care facilities and services.

The program functions by requiring review and approval of certain types of proposed health care facility and service projects by the Maryland Health Care Commission. Approved projects are awarded a Certificate of Need, authorizing the project applicants to implement the approved project within the approved spending level and on a timely basis. The policy objectives and standards established by the Commission in the State Health Plan provide the basis for review of proposed projects.


With certain exceptions, a Certificate of Need is required to:

  • Build, develop, or establish a new health care facility;
  • Move an existing health care facility to another site;
  • Change the bed capacity of a health care facility;
  • Change the type or scope of any health care service offered by a health care facility; or
  • Make a health care facility capital expenditure that exceeds a threshold established in Maryland statute.

Review Criteria

Maryland law requires that the Commission consider six criteria in its review of CON applications:

State Health Plan. An application for a CON shall be evaluated according to all relevant State Health Plan standards, policies, and criteria. (For specific information on State Health Plan standards, Click here)

Need. The Commission shall consider the applicable need analysis in the State Health Plan. If no State Health Plan need analysis is applicable, the Commission shall consider whether the applicant has demonstrated unmet needs of the population to be served, and established that the proposed project meets those needs.

Availability of More Cost-Effective Alternatives. The Commission shall compare the cost effectiveness of the proposed project with the cost effectiveness of providing the service through alternative existing facilities, or through an alternative facility that has submitted a competitive application as part of a comparative review.

Viability of the Proposal. The Commission shall consider the availability of financial and nonfinancial resources, including community support, necessary to implement the project within the time frames set forth in the Commission’s performance requirements, as well as the availability of resources necessary to sustain the project.

Compliance with Conditions of Previous Certificates of Need. An applicant shall demonstrate compliance with all terms and conditions of each previous Certificate of Need granted to the applicant, and with all commitments made that earned preferences in obtaining each previous Certificate of Need, or provide the Commission with a written notice and explanation as to why the conditions or commitments were not met.

Impact on Existing Providers and the Health Care Delivery System. An applicant shall provide information and analysis with respect to the impact of the proposed project on existing health care providers in the health planning region, including the impact on geographic and demographic access to services, on occupancy, on costs and charges of other providers, and on costs to the health care delivery system.

Last Updated: 1/26/2015