Certificate of Need (CON) Overview
The South Carolina Department of Health and Environmental Control administers the South Carolina CON program. The purpose of South Carolina’s CON program is to promote cost containment, prevent unnecessary duplication of health care facilities and services, guide the establishment of health facilities and services that will best serve public needs, and ensure that high-quality services are provided in health facilities in the State.
Services that Require CON
South Carolina requires CON approval for any health care facility proposing the changes listed below. A health care facility is defined as an acute care hospital, psychiatric hospital, alcohol and substance abuse hospital, nursing home, ambulatory surgical facility, rehabilitation facility, residential treatment facility for children and adolescents, intermediate care facility for persons with intellectual disabilities, inpatient hospice facility, or radiation therapy facility.
- Construction or establishment of any of the health care facility types listed above
- A capital expenditure in excess of $2,000,000
- Change in the bed complement of an existing facility through the addition of beds or the change in licensure classification of beds
- Offering any new health service that was not offered at the facility in the preceding twelve months
- Health services are defined as clinically related, diagnostic, treatment or rehabilitative services, and includes certain alcohol, drug abuse and mental health services
- The acquisition of major medical equipment used for diagnosis or treatment with total project cost in excess of $600,000
What Criteria are Used to Review a CON?
The Department of Health and Environmental Control is required to notify an applicant of the relative importance of the project review criteria to be used in reviewing its’ application. This notification is made once an application is deemed complete. The criteria to be used in reviewing all CON projects are listed below. There are additional project-specific criteria, including numeric need formulas for some services. No project shall be approved unless it is consistent with the State Health Plan.
- Need for the proposed project, which includes accessibility and distribution of health resources
- Economic considerations, which include the financial feasibility of the project, projected revenues, funding, financing, consideration of alternatives, and cost containment.
- Health system resources, which includes staffing considerations, adverse impact on existing facilities, and access to professional schools and training programs
- Site suitability, which includes zoning, utilities, site size, environmental considerations and square footage
- Special considerations:
- Medically underserved groups
- Other entities (medical schools, training schools, multidisciplinary clinics)
- Safety
Certificate of Need Process Milestones
- Public Notification Within twenty (20) days prior to submission of an application, the applicant must file notification in the legal section of a daily newspaper in the project’s proposed service area. The notification must run for three consecutive days and must include: 1) a statement that a CON is being applied for; 2) a description of the project; and 3) the estimated project capital cost.
- Application Submission Two copies of the application and the non-refundable filing fee must be submitted to the Department.
- Additional Information Within 30 calendar days of accepting an application, the Department can request any additional information deemed necessary to make the application complete. The applicant has 30 days from the date of the request to submit the requested information. If no additional information is submitted, the application is withdrawn from review.
- Payment of Application Fee When the application is deemed complete, the Department will invoice the applicant for the CON fee, which must be paid by check within fifteen calendar days of receipt. When the application fee is complete, the Department will publish a notice in the State Register that the review cycle has begun.
- Public Hearing A hearing can be requested by an affected person within 30 days of notification of the beginning of the review. The public hearing provides an opportunity for any person to present information relevant to the application.
- Decision The Department will make its decision on the application no earlier than 30, but no later than 120 calendar days from the date of publication in the State Register, unless a public hearing is held, in which case the decision will be rendered no later than 150 days after affected parties are notified the application was deemed complete.
- Appeals Any Department decision involving the issuance, denial, or revocation of a CON may be appealed by an affected person.
- Progress Updates The applicant is required to submit quarterly progress reports that correspond with the timetable included in the approved CON, beginning 90 days after receipt of the CON certificate. The applicant must submit a final completion report after the project has been fully implemented, containing information on total project costs, design specifications, services and equipment inventory, and a list of average charges and costs for services.
Certificate of Need Application Fees
The non-refundable initial filing fee is $500. The application fee is one half of one percent (.5%) of the total project cost, which is payable when the project is deemed complete. The application fee shall not exceed $7,000.
South Carolina also has a CON issuance fee of $7,500 for any project with a total cost exceeding $1,400,000. This fee is payable within fifteen days of receipt of the CON certificate.
Additional Sources
(links good as of January 2022)
South Carolina Department of Health and Environmental Control, Certificate of Need
https://scdhec.gov/health-regulation/health-facility-regulations-licensing-con/certificate-need
2010 CON Act
https://www.scstatehouse.gov/sess118_2009-2010/bills/337.htm
CON Statute (Section 44-7-110 to 44-7-230)
https://www.scstatehouse.gov/query.php?search=DOC&searchtext=44%207%20120&category=CODEOFLAWS&conid=36924252&result_pos=0&keyval=19141&numrows=10
CON Regulations
https://scdhec.gov/sites/default/files/Library/Regulations/R.61-15.pdf
State Health Plan
https://scdhec.gov/sites/default/files/media/document/2020_South_Carolina_Health_Plan-June_12_2020_0.pdf
CON Application Forms
https://scdhec.gov/certificate-need-application-con
Contact RPC Consulting
Should you or your client need an expert team to help you with the South Carolina 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 based on sources believed to be reliable. It was updated in January 2022. 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.