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Application and Filing Fee Submission Process due to the pandemic
HSDA Rulemaking (Updated)

CON Process and How to Apply

Certificate of Need Process

  1. A CON application is commenced by the filing of the Letter of Intent at the Agency office between the 1st through the 10th of any month.  The information contained in the Letter of Intent must be published in a newspaper of general circulation in the community in which the project will be located during that same 10-day period.
  2. The CON application and filing fee are due in the Agency's office within five days of publication.  If the applicant's application is denied by the Agency, the applicant may request a refund equal to 25% of the filing fee.
  3. The application will be reviewed by agency staff for completeness during which time additional questions may be asked.  Upon being deemed complete, the application will enter the next review cycle.
  4. A review cycle start on the first day of each month, as specified in Agency Rules.
  5. The review cycle is typically 60 days.  Under certain circumstances, an application may be considered for a shorter 30 day period.  This is only possible when it appears that all criteria necessary for granting a Certificate of Need are met and there is no opposition.  The executive director will make a decision whether a shorter review period is possible upon request prior to the application entering the review cycle.
  6. During the 60 day review cycle, the application is analyzed by the Department of Health, Department of Mental Health and Substance Abuse Services, and/or the Department of Intellectual and Developmental Disabilities.  The reviewing agency will generate a written report and submit it for consideration by the Agency with the application and all related materials at the next regularly scheduled.
  7. Application materials, including a staff summary and the reviewing agency report, will be forwarded to the 11 member board about 12 days prior to the meeting in which the application will be heard.
  8. During the Agency meeting at which the application is being heard, the applicant will make a short presentation (10 minutes) highlighting how the application meets the criteria necessary for granting a Certificate of Need application.
  9. Persons supporting and/or opposing the application will have an opportunity to provide testimony.
  10. Agency members will ask questions of the applicant and any supporting and opposing party and then discuss the application in the public forum.
  11. The Agency will then vote to approve or deny the application.  In certain circumstances, an application may be deferred so additional information may be obtained.
  12. Approval/Denial letters will be issued within a week of the Agency's decision.  The actual certification will be issued within 4 weeks of the decision.
  13. Agency decisions may be appealed up to 15 days under certain conditions as noted in T.C.A. §68-11-1609(g)(1) & (2).  The appeal process is more fully described in T.C.A. §68-11-1610.

The Certificate of Need Flowchart (below) will help provide a visual diagram of the process.

Certificate of Need Process Flow Chart

(Notice to Applicants filing CON applications for cardiac catheterization services:  The current criteria and standards for review of cardiac catheterization CON applications utilize diagnostic-equivalent procedure and weights for measuring laboratory capacity.  The resulting weighted procedures are used in evaluating applications with respect to minimum volume standards.  This data is available by request at the website of the Department of Health (TDH).  An applicant should request diagnostic equivalent cardiac catheterization data for the three most recent years available for all hospital cardiac catheterization providers within the declared service area at the following Department of Health/Health Statistics Site .  Applicants should plan on requesting and receiving this data from TDH at least 2 weeks prior to filing the CON application.)


How to Apply for a Certificate of Need

A Certificate of Need can only be granted when a project is necessary to provide needed health care in the area to be served, can be economically accomplished and maintained, will provide health care that meets appropriate quality standards and will contribute to the orderly development of adequate and effective health care facilities and/or services.  The applicant is responsiblefor demonstrating these criteria has been met through its answers to the CON application and any supplemental questions posed by staff.

Applicants unfamiliar with the Tennessee Certificate of Need program are strongly encouraged to contact HSDA staff for a pre-filing conference.  Conferences may be held in person or via telephone any business day, 8:00 am through 4:30 pm (Central Time).  Please contact Deputy Director Phillip Earhart at or call 615-741-2364 to set up an appointment.

Please visit FORMS (in the website header) for all the necessary forms you will need to file an application.  The Letter of Intent (LOI) and Publication of Intent (POI) forms contain certain required information so please use the forms so your publication will be correct.