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05.19.2022 Legal News

First Look at 2023 New North Carolina Health Care Opportunities & Call for Petitions

Through North Carolina’s annual Healthcare Planning process, providers now have a first look at the opportunities expected to be identified for 2023 Certificate of Need (CON) proposals. The Proposed State Medical Facilities Plan (SMFP) is expected to include a range of Need Determinations for new Home Health Agencies and MRI Scanners across the State.  

Those interested in adding capabilities that are not identified as a need have the option to file Petitions to request adjusted Need Determinations. Although July 27, 2022 is the outside deadline for Petitions, Petitions should be prepared now to allow time for Petitioners to offer presentations to the State Health Coordinating Council members in the series of upcoming Summer Public Hearings.

Home Health Agencies

Home Health Agency (HHA) needs are a highlight of the evolving planning landscape with initial indications showing a need for one (1) new HHA in each of the following Counties:

Brunswick       Catawba     Edgecombe        Forsyth       Granville     Guilford
Montgomery   Nash           New Hanover     Onslow       Pitt              Robeson


Magnetic Resonance Imaging (MRI) scanner needs are sharing the spotlight with the State expected to identify several opportunities for providers to apply to secure CON approvals to acquire new MRI scanners in various areas of North Carolina in 2023, including:

Brunswick       Cleveland        Duplin             Durham/Caswell         New Hanover
Pitt/Greene/Hyde/Tyrell          Randolph        Stanly                         Wake


Although the last Planning Committee Meeting included an oral announcement of “no need” for Positron Emission Tomography (PET) scanners, a published table shows need in two (2) of the State’s Health Service Areas. The 2021 SMFP contained four (4) Fixed PET Scanner Need Determinations, including a need for one (1) Fixed PET Scanner in each of the following Service Areas: 

Health Service Area

CON Beginning

Review Date

Approved Date

CON Issued


Health Service Area I

May 2021

September 2021

February 2022


Pending Development

Health Service Area IV


July 2021


November 2021

December 2021


Pending Development

Health Service Area V


November 2021



March 2022


April 2022


Pending Development

Health Service Area VI


October 2021


December 2021

January 2022


Pending Development

For Part 1 (Table 17F-1), application of Step 4 of the Methodology calls for subtractions to adjust for placeholders for CON-approved scanners and for Need Determinations in previous SMFPs.

To calculate the need determination for the service area, add all facility deficits (Column F) and adjust the sum by the number of placeholders for CON-approved scanners and need determinations in previous SMFPs. The total is the need determination for an additional fixed PET scanner except as provided in Step 7 for both parts of the methodology combined (Column G). (Emphasis added.)

Accordingly, a corrected Table 17F-1 would reflect a subtraction or “-1” in each of the above Health Service Areas for the CON-approved scanners that are pending development and, thus, no PET Need Determinations in any areas of the State.

Nursing Facility and Adult Care Home Beds / Hospice Inpatient Beds

Initial indications show no need for new nursing homes and a need for only 30 adult care home beds in Anson County and 20 adult care home beds in Swain County. As has been the case for years, providers looking to add long-term bed capacity will be relegated to acquiring existing beds. A need for eight (8) hospice inpatient beds is expected for Cumberland County.

Psychiatric / Chemical Dependency Treatment Center Beds

The need methodologies for psychiatric and chemical dependency treatment center beds are no longer a feature of the SMFP meaning providers are free to apply for CON approvals without awaiting the identification of Need Determinations. Proposals are still subject to CON review, including the requirement to demonstrate need, but proposals can be filed in any area of the State in accordance with the Schedule for Reviews, which will be included in the final SMFP.  

ORs / Cardiac Cath / Linac

Initial indications show no Need Determinations for new operating rooms (ORs) anywhere in the State. Physician groups interested in additional OR capacity will need to pursue a summer Petition to seek a Need Determination to allow for the potential to apply for a new OR in the coming year.

Cardiac catheterization (Cardiac Cath) equipment can be approved for development on hospital sites or in licensed ambulatory surgical facilities (excluding endoscopy-only facilities). The State is forecasting potential Cardiac Cath equipment needs in Johnston, New Hanover, Orange, and Wayne Counties. A linear accelerator (Linac) need is suggested for Service Area 14, which includes Chatham and Orange Counties.  

More to Come

Following the May meeting of the Long-Term Care and Behavioral Health Committee, the State Health Coordinating Council (SHCC) will convene on June 1, 2022. A proposed SMFP will be made available to the public on or about July 1, 2022. The SHCC will then hold the Summer Public Hearings in July to receive comments and petitions for adjustments to the Need Determinations in the proposed SMFP. Ultimately, the proposed SMFP will be presented to the Governor for review and approval by the end of the year. With approval, the SMFP will once again become the official document for health facility and health service planning in North Carolina for the year.