Ohio Certificate of Need (CON) Overview

Ohio has a CON process in place for long-term care services and facilities. Winning approval for a CON application is often a time consuming and difficult undertaking. Working with RPC provides clients with a team of consultants with experience working with CON projects.

When working on a CON project, RPC can prepare the entire CON application or sections of the application as the client prefers. When the client is defining the project and deciding whether to apply, RPC can help assess the market and regulatory situation to determine the relative likelihood of success for a project. RPC not only completes a thorough review of the competitive environment, market need and financial analysis, but also works seamlessly with the client’s staff, architects, engineers, and other outside consultants to create a solid CON application.

RPC is led by Ron Luke, JD, PhD, who has prepared CON applications and presented testimony in CON hearings since 1981 in over 20 states.  RPC’s work on CON projects includes the opening of new acute care hospitals, hospices, physical rehabilitation and psychiatric specialty hospitals, ambulatory surgery centers and nursing homes, the relocation and addition of beds, and acquiring major medical equipment. Working with RPC during the CON process gives the applicant the advantage of a skilled, experienced team that can provide expert advice and produce an effective CON application.

State Agencies

Ohio Department of Health
The staff at the Ohio Department of Health (ODH) assists the Director in all aspects of the CON application process and enforcement.

Ohio Department of Health
Office of Health Assurance and Licensing / Health Care Services Section
246 North High Street
Columbus, OH  43215
(614) 466-3325

Director of Health
The Director holds complete authority to render final decisions on applications.  He also publishes county bed need figures for comparative reviews.

Services that Require CON

The Ohio Certificate of Need Program ensures the public access to quality, long-term care (LTC) services by requiring review and approval of activities involving LTC beds. However, the ODH states that there is essentially a moratorium on new LTC beds. An increase in LTC bed capacity, or the development of a new LTC facility can only be accomplished through a comparative review process or relocation of existing long term care beds. The following activities require a Certificate of Need review and approval:

  • Development of a new LTC facility
  • Replacement of an existing LTC facility
  • Renovation of a LTC care facility that involves a capital expenditure of $4,000,000 or more (not including equipment)
  • Increase in LTC bed capacity
  • Relocation of LTC beds from one site to another
  • Failure to conduct a reviewable activity in substantial accordance with the approved Certificate of Need application, if the change is made within five years after implementation
  • Expenditure of more than 110% of the maximum expenditure specified in an approved Certificate of Need application

Certificate of Need Process Milestones

Except for the applications filed under Section 3702.593, Ohio Revised Code, a Certificate of Need application form may be filed with the Department of Health at any time. Applications for the relocation of LTC beds to a county with fewer LTC beds than needed under Section 3702.593, Ohio Revised Code, may be filed in the first January of the specified review period. Each review period lasts four calendar years; the current period ends December 31, 2023.

An applicant for the normal review process follows the steps below.

  1. File Application
    The applicant files one original and one copy. The application includes a timetable, specific location for the project, contact information for an authorized representative, and application fee. A decision is generally rendered within four to six months of submission, provided no objections to the project are filed.
  2. Completeness Review
    Within 30 days of submission, the ODH will either declare the application complete and reviewable or request more information. The Director may make two requests for additional information. The applicant has 30 days from the date of the request to respond with the necessary information. The Director shall mail the applicant a notice of completeness or deem the application incomplete no later than 30 days after the response to the second information request has been received.
  3. Written Comments

Any affected person can submit written comments regarding an application for a CON. Written comments must be received by the 45th day after the application is accepted for processing (the date it is made available for public review on the Department of Health website). The Director must consider all comments received.

  1. Director’s Decision
    The director renders a decision within 60 days of the notice of completeness, unless an extension of 30 days has been granted by the director.

 

  1. Adjudication Hearing
    The applicant may appeal a decision to grant or deny a CON application within 30 days of the Director’s decision.  The Director then holds an adjudication hearing.
  1. Appeal

The applicant can appeal the adjudication decision to the 10th District Court of Appeals no later than 30 days after the Director’s adjudication order is mailed.

What criteria are used to review a CON?

In his review, the Director examines:

  • Construction projects: costs, methods, type of construction, current and projected zoning status of the site, and space allocations and configurations for the existing and proposed areas
  • Relationship to applicant’s long-range plan
  • Needs of the population that the project would serve, focusing on:
    • current and proposed primary and secondary service areas
    • travel times and accessibility of the project site versus similar sites
    • current and projected patient origin data, by zip code
    • special needs and circumstances of the applicant or population to be served by the proposed project
    • special needs related to any research activities
  • Impact to other providers of similar services in the service area (utilization, market share and financial status)
  • Alternatives to the project and the advantages, disadvantages and costs of each alternative
  • Historical, current, and projected utilization of the facility and specific services (for review of an existing facility’s project)
  • Effectiveness of the project in meeting the needs of medically underserved groups and historical experience in meeting their needs
  • Short-term and long-term financial feasibility, cost effectiveness, and financial impact, especially:
    • financing sources
    • operating costs of new services and the total facility
    • effect on charges and payment rates
    • costs and charges compared to similar providers
    • historical cost-effectiveness of applicant
  • Impact of the project on staffing levels and availability of personnel resources
  • Impact on continuing education
  • Impact on/availability of ancillary and support services
  • Compliance with licensure, certification, and accreditation standards
  • Special needs of facilities with religious affiliations
  • Special needs of inner city and rural communities
  • Historical performance of applicant’s previous CON projects

The Director conducts a comparative review by considering the normal criteria and giving additional priority to projects:

  • That are part of a continuing care retirement community (CCRC)
  • That serve a medically underserved population
  • That provide alternatives to institutional care
  • Where the facility’s owner or operator will participate in Medicaid waiver programs that provide alternatives to institutional care
  • That have positive resident and family satisfaction surveys
  • That involve facilities with fewer than 50 beds
  • That are located within the service area of a hospital
  • That involve facilities that are nurse aide training and testing sites
  • That have a four-star or five-star rating from the Centers for Medicare and Medicaid Services

Certificate of Need Application Filing Fee

The filing fee, accompanying the application at the time of filing, is equal to the greater of $5,000 or 1.5 percent of the capital expenditure proposed, with a maximum fee of $20,000.

Additional Sources

(links good as of January 2022)

Department of Health, Certificate of Need
https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/certificate-of-need

CON Statute
http://codes.ohio.gov/orc/3702

State CON Rules
https://codes.ohio.gov/ohio-administrative-code/chapter-3701-12

Frequently Asked Questions
https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/certificate-of-need/resources/confrequentlyaskedquestions

CON Application Forms
https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/certificate-of-need/resources/conapplicationandforms

Contact RPC Consulting
Should you or your client need an expert team to help you with the Ohio Certificate of Need Process (CON) please contact Dr. Ron Luke at 512-371-8166.

Disclaimer: The information on this page has been compiled by RPC in June 2010 and updated in January 2022 based on sources believed to be reliable. Where possible we have had the material reviewed by state CON officials or others knowledgeable of the state’s CON program. The information is not offered as legal advice. A state may change its rules, forms and procedures at any time and RPC offers no assurance that the information will be correct on the date it is viewed. Therefore the reader is urged to use this information only as a starting point for any CON application and to speak with state officials or seek legal or consulting advice early in the process.