New York’s Certificate of Need (CON) program—governed by Public Health Law Article 28—has historically required state approval for most health facility construction, expansion, or substantial modification. This process was meant to control costs, ensure public need, and promote quality, but often resulted in lengthy delays even for small-scale projects or routine repairs.
On August 6, 2025, following advocacy from medical societies, hospitals, and provider associations, the New York State Department of Health (DOH) adopted sweeping amendments to CON rules (published at 10 N.Y.C.R.R. Part 710; see official summary in the New York State Register, Vol. XLVII, Issue 31).
What’s New for Small Providers?
Higher Cost Thresholds: Clinics, ambulatory surgery centers, and primary care practices now face CON review only for projects with costs above $8 million (previously $6M). For non-hospital facilities, the full review threshold rose to $20 million. The intent is to let community providers upgrade or modernize facilities without navigating red tape.
Exemptions for Routine Improvements: Facility repairs, upgrades to IT systems, and acquisition of newer exam room equipment—if under threshold—now only require a written notice to DOH, rather than a full CON filing. This is a huge time-saver, especially for independent and smaller groups.
Simplified Pathways: Grants, mobile health projects, and certain diagnostic equipment (MRI, CT) are explicitly eligible for limited or administrative review—which is faster, less expensive, and less resource-intensive for smaller facilities.
Architectural Self-Certification: Any project up to $30 million can move ahead with professional self-certification, avoiding DOH plan review delays as long as codes are met.
Bundled Filings: All CON applications for a project must be filed together, which helps small providers avoid piecemeal submissions that often delayed approvals.
Practical Considerations for Providers:
Review Current and Upcoming Projects: Assess whether planned capital improvements qualify for limited review, administrative review, or exemption under the revised thresholds. Projects underway or pending submission may benefit from reclassification or expedited review.
Maintain Compliance: Regardless of review level or exemption, all projects must continue to meet applicable state and federal building codes, NFPA life safety standards, and Centers for Medicare & Medicaid Services (CMS) requirements where relevant.
Exclusions Remain: Projects adding or modifying clinical services, significantly changing bed counts, or resulting in major operational changes—such as changes in ownership—still require full CON review
Review Your Projects: Many routine upgrades may be exempt from review or eligible for expedited process under new thresholds.
File Correct Notices: For exempt projects, ensure you submit written notification to DOH for compliance
Look Out for Grants: State-funded projects and mobile initiatives get special treatment under new rules.
Did You Know?
New York was among the last states with the most stringent CON rules for non-hospital projects—these reforms now place it into alignment with states like Connecticut and Massachusetts, where thresholds have been raised and routine upgrades are fast-tracked.
NYSDOH will review the impact of these changes in 2030, meaning further updates may occur if smaller providers still face barriers.
Recent NY State Senate bills (like 2025-S6981A) and official commentary note a particular emphasis on aiding home health, behavioral health, and rural providers, with targeted support and flexibility for underserved areas and populations.
Outlook:
These reforms align New York with a broader national trend towards modernizing Certificate of Need laws to facilitate timely upgrades and expansion while preserving necessary regulatory oversight for major changes. Providers should familiarize themselves with the new regulations, published guidance, and NYSDOH’s current interpretations. The Department has indicated there may be unique circumstances requiring direct consultation and reference to the full regulations for final determination of review level.
Our team is available to evaluate how these regulatory changes affect your projects and compliance obligations, advise on strategic planning for facility improvements, and assist with the preparation and submission of required filings under the new framework. Contact us at info@mdrxlaw.com or by calling our firm at (212) 668-0200
