Significant Changes to Rhode Island Certificate of Need Review

By Patrick N. Sampson on June 15, 2026

On June 12, 2026, Governor Daniel McKee signed into law the State’s Fiscal Year 2027 budget legislation, which includes amendments to Rhode Island General Laws Chapter 23-15, entitled “Determination of Need for New Healthcare Equipment and New Institutional Health Services” (the “CON Statute”). The amendments to the CON Statute significantly narrow the categories of healthcare services and equipment requiring Certificate of Need review (“CON Review”) by The Rhode Island Department of Health (“RIDOH”) and streamline the review process. Highlights include:

• CON Review for new healthcare facilities is limited to hospitals (other than hospitals whose services are limited exclusively to behavioral health), nursing facilities, hospice providers, inpatient rehabilitation hospital centers, and free-standing emergency care facilities. Significantly, CON Review is no longer required for home nursing care providers, home care providers, surgicenters, multi-practice physician ambulatory surgery centers, or multi-practice podiatry ambulatory surgery centers.
• CON Review for capital expenditures for physical improvements and the acquisition of existing buildings, land and/or interest in land is required only if the associated costs are in excess of $50 million.
• CON Review for any new or expanded service or equipment is now limited to cardiac catheterization, open-heart surgery, organ transplantation, particle accelerator-based radiation therapy, and neonatal intensive care services. Computerized axial tomography (CT), full body magnetic resonance imaging (MRI), positron emission tomography (PET), and PET/CT no longer require CON Review.
• CON Review is no longer required for the addition of a health service (except as listed above) or changes in the bed capacity of a healthcare facility
• Although CON approval requires a finding of need and affordability, the amendment changes the mandatory review criteria for the Health Services Council (“HSC”) recommendation to RIDOH. The HSC may assess criteria including, but not limited to, affordability, accessibility, innovation, and quality standards to be further defined in regulations adopted by RIDOH. Innovation is defined as the potential of the proposal to demonstrate or provide one or more innovative approaches of methods for attaining a more cost effective and/or efficient healthcare system, to be further defined in regulations adopted by RIDOH.
• CON approvals may be subject to conditions as necessary to promote affordability, accessibility, innovation and quality standards.
• The amendment changes the timetable for CON Review:
  • RIDOH must initiate review no later than 31 days after the filing of a CON application.
  • Next, the HSC must make its recommendations relative to approval or denial to the Director of the Department of Health (the “Director”) within 115 days of initiation of review.
  • Finally, within 10 days of the determination of the HSC, the Director must render his or her decision in writing.
• The definition of an “Affected Person,” who may comment on any CON Application, has been changed and is limited to the applicant, the state medical society, the state osteopathic society, those voluntary nonprofit areawide planning agencies that may be established in the state, any hospital or medical service corporation under the laws of the State and those members of the public who are to be served by the proposal. Affected Person no longer includes healthcare facilities located within the State that provide institutional health services.
• RIDOH is authorized to adopt regulations for procedures for reconsideration of CON Application decisions. The procedure for administrative review of a CON decision at the agency level has been removed. Any appeal to the Superior Court pursuant to the Rhode Island Administrative Procedures Act is now limited to the Applicant. Additionally, RIDOH is authorized to adopt regulations for expeditious review.
• The period to implement a CON approval has been enlarged and must be initiated within two years of the date of approval.
• The Applicant’s obligation to pay for experts in connection with review of CON Applications has been increased to a maximum of $50,000.
• RIDOH is authorized to adopt regulations to further the accomplishment of the purposes of the amendments to the CON Statute.

For CON Applications filed in the June 2026 cycle, that no longer require CON Review, RIDOH is working to confirm how those applications will be treated and whether any other review (e.g., initial licensure review) will be required. We are continuing to monitor announcements from RIDOH and initiation of adoption of regulations as authorized by the amendments to the CON Statute.

For questions on the amendment, its effects, and any other necessary RIDOH review for proposed projects, please contact Pat Rocha, Leslie Parker or Pat Sampson.