Breaking Down Tennessee’s Health Care Reform: The End of Certificate of Need Requirements for New Facilities and Services

In recent years, Tennessee lawmakers have been actively working to reform the burdensome certificate of need (CON) requirements for establishing new health care facilities and services in the state. Historically, Tennessee’s CON law mandated approval by the state before entities could initiate or expand specific types of facilities and services, leading to a long list of restrictions. However, on April 23, 2024, legislators passed legislation (HB 2269) that eliminated the need for the state’s prior approval for certain services and aimed to improve access to care. The new law also mandates the Health Facilities Commission to conduct a six-year plan of study on the impact of CON reform and facilities licensure in the health care industry, signaling the potential for further reforms in the future.

The types of health services impacted by the legislation include new hospital emergency rooms, ambulatory surgical treatment centers, intellectual disability institutional habilitation facilities, MRI and PET services, long-term care hospitals, linear accelerators, and open heart surgery. The changes outlined in the legislation will take effect at different times, depending on the type of health service.

For example, as of July 1, 2025, hospitals will no longer require a CON to establish satellite emergency department facilities within 10 miles of their main campus provided they are at least 10 miles away from any actively licensed acute care hospital or satellite emergency department facility. Similarly, as of December 1st