What Are CON's Benefits?
The benefits of CON can reach beyond the issues of cost containment and
- CON helps to ensure appropriate quality and distribution of services,
allowing health care providers to maintain sufficient manpower to
deliver high quality care.
- CON encourages health care facilities/providers to develop long-range
operational and capacity plans based on local community health care
- CON requires consideration of personnel and financial feasibility
as well as need.
- CON encourages the development of affordable and accessible health
services to all areas of the state.
- CON encourages the consideration of more cost-effective strategies
through the review of alternative services.
- CON promotes the sharing of services, especially in rural areas,
where operational and administrative costs can threaten facility
- CON offers a forum for public input and community involvement prior
to the establishment of facilities and services.
Anyone interested in completing a CON application must refer to the laws,
rules, and guidelines pertaining to CON. These include:
- Montana Code Annotated (MCA) 50-5-301-310;
- Administrative Rules of Montana (ARM) 37.106.101-140;
- The Current State Health Care Facilities Plan (SHCFP).
Not all health care facilities or services are reviewable for Certificate
of Need. The facilities and services subject to review include:
- Ambulatory surgical facilities proposed for counties with populations
less than 20,000
- Home health agency services
- Inpatient chemical dependency facilities
- Intermediate care facilities for persons with mental retardation
or developmental disabilities (ICFs/MR or DD)
- Nursing home services
Reviewable or Not?
Reviewable projects primarily involve large capital expenditures or expansions
in bed capacity or services by the types of facilities previously listed
above. Projects that require CON review include:
- Capital expenditures over $1,500,000.
- Changes in bed capacity of a facility through an increase in number,
or relocation, of beds.
- Addition of health services associated with annual operating expenses
of $150,000 or more.
- Construction, development, or establishment of a facility
- Establishment of a home health agency or expansion to another service
- Use of hospital beds (more than five) to provide skilled nursing
care (swing beds).
Some projects may be non-reviewable, and may forego the full CON review.
If the facility informs the Department of its intentions in advance. For
example, with a letter of intent:
- Initial establishment of five or fewer swing beds is non-reviewable.
- Addition of ten beds, or 10% of licensed beds, whichever
is less, is non-reviewable (provided there has been no change to
the facility's license in two years).
- Changes of ownership are non-reviewable (with notification
30 days ahead of transaction).
WITHOUT PROPER NOTIFICATION, THESE "NON-REVIEWABLES" CAN
Any health care facility considering development is advised to contact
the CON Program BEFORE proceeding with the project, to determine if the
project is reviewable.
In addition, we recommend that CON applicants consult with the Department's
Licensure and Certification Bureaus to ensure compliance with other state
and federal standards.
How Does the Process Work?
Generally, CON reviews take at least six months to complete, and follow
the process below:
- An applicant files a Letter of Intent (LOI), declaring their
intent to submit an application for the proposed project.
- The Department publishes a list of all Letters of Intent
received during the preceding calendar month on the 10th of every
month in the nearest newspaper(s) for which an LOI has been filed.
- Anyone may submit a competing LOI within thirty days after
- After thirty days, the Department notifies the applicant(s)
of the deadline for submission of application(s), giving each applicant
- The applicant may submit the application anytime within the
deadline period. Along with the application, the applicant must
pay the required fee ($500 or 0.3% of the project's capital expenditure,
whichever is greater).
- The Department's 90-day decision deadline begins upon receipt
of an application and fee. In comparative reviews, the decision
deadline period begins upon receipt of the last application and
- The Department determines if an application contains the
required information, and can ask additional questions if necessary.
- Public informational hearings may be held within the Department's
90-day decision period.
- The Department renders a decision by the 90th day; affected
parties then have 30 days to request a reconsideration of the decision.
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