Washington, D.C. Certificate of Need Requirements: Facility Guide
Certificate of need (CON) laws require that healthcare providers obtain approval before taking actions that could significantly impact a region’s healthcare system. Only some states use this regulatory mechanism, and the degree of regulation varies by state (or federal district). In Washington, D.C., certificate of need laws are extensive and cover a wide range of facility types, from hospitals to home health agencies, as well as many activities.
If you’re planning to establish a new healthcare facility or expand your offerings to patients, it’s important to understand the CON regulations, as well as the public health data and strategies they are based on.
Washington, D.C. Certificate of Need Laws at a Glance
Making changes to the healthcare landscape in Washington, D.C. may require a certificate of need. D.C.’s approval process is complex, so we put together a summary of key information in one convenient chart to help you learn the basics and organize your approach.
| Legal Authorities | Code of the District of Columbia, Title 44, Chapter 4:
D.C. Municipal Regulations, Title 22, Subtitle 22B: |
| Covered Entities, Services, or Actions | The State Health Planning and Development Agency (SHPDA) oversees D.C.’s certificate of need program. CON regulations cover a broad spectrum of healthcare facilities, including:
The regulations cover healthcare providers or corporate entities who plan to take other actions that would impact the healthcare system in the District, such as:
Some entities, actions and services are exempt from CON regulations, such as:
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| Establishment of Need | Proposals are evaluated by SHPDA, along with the Statewide Health Coordinating Council (SHCC) and the Project Review Committee (PRC), guided by the Department of Health’s latest Health Systems Plan (HSP)andAnnual Implementation Plan for the HSP. The plans outline current public health strategies, areas of focus, and priorities, such as:
The review process includes evaluation of whether the proposed project is aligned with the priorities articulated in the HSP. Applications must demonstrate an explicit connection to public need, based on objective data. |
| Duration of Process | The D.C. certificate of need application process may take up to six months. |
| Enforcement Agency | The State Health Planning and Development Agency within the District of Columbia Department of Health is responsible for enforcing CON regulations. |
| Fees | The fee for applying for a CON in Washington, D.C. is the greater of 3% of the proposed capital expenditure or $5,000, with a cap of $300,000. There are some exceptions to this method of calculating fees, including:
*Note: The D.C. SHPDA may establish a fee schedule (paid on a quarterly basis) with private hospitals in lieu of a CON application fee. |
| Application Forms | The D. C. certificate of need application process involves:
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| Penalties | Entities or providers that fail to comply with the regulations may face sanctions that include:
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Too Restrictive or Just Right?
There are 35 states that use CON processes to regulate a variety of healthcare services, facility types, and activities. Research conducted and published by the D.C. Department of Health (DOH) compared CON programs in different areas of the country and found that the number of services, facilities, and activities covered ranged from 1 (Indiana) to 28 (Hawaii).
On this scale, D.C.’s program ranks high, with 25 facilities/services regulated. Critics argue that the relatively strict regulations decrease service options for residents by sending providers across the border to Virginia or Maryland, rather than seeking a D. C. certificate of need. DOH’s Health Systems Plan maintains that service capacity is not the challenge that the District’s health system faces.
Influencing Public Health by Requiring a Certificate of Need: D.C.’s Strategy
According to the HSP, the challenge lies in strengthening the existing healthcare system through better communication between providers, more collaboration and partnerships within the system, and implementation of evidence-based protocols and services to address health disparities. DOH also advocates for improving health literacy and prevention efforts, among other strategies. These public health priorities, shared publicly every five years in the HPA, guide the CON approval process.
Get Support as You Expand Your Facility
Navigating the D.C. certificate of need application process is just one of the tasks you’re balancing as you work toward reaching your facility’s potential. We’re here to support you with expert-written facility guides and resources that provide you with essential information when you need it most.
Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.