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10.10.2022 Legal News

Update: 2023 North Carolina Health Care Opportunities - The State Plan Heads to the Governor

The State Health Coordinating Council met before a packed house on site at the Dix Campus to take its final votes recommending the Need Determinations for new North Carolina health care capacities for 2023. 

The Council voted on various Petitions resulting in several twists on the Need Determinations revealed earlier this year.     

The next step will be the presentation of the Proposed State Medical Facilities Plan (State Plan) to Governor Roy Cooper for review and signature. The State Plan will be final by year-end and will guide providers across North Carolina in pursuing new health care offerings in the coming year. 

Home Health Agencies

A “compromise” vote followed a Petition on the Home Health Agency (HHA) Need Determinations. Initial indications called for a dozen HHA Need Determinations; the Council instead voted to recommend HHA Need Determinations in five (5) counties:

  • Brunswick      
  • Forsyth     
  • New Hanover     
  • Onslow       
  • Pitt     

A Home Health Methodology Work Group chaired by Dr. Greene will convene on October 11, 2022, at 10:00 a.m. via WebEx.          


The Council voted for a Need Determination for three (3) additional mobile Magnetic Resonance Imaging (MRI) scanners to operate within a statewide service area.

The Council voted for a Petition for an adjusted Need Determination for a fixed MRI in Caldwell County. With that, the Council voted for ten (10) fixed MRI Need Determinations, one in each of the following Counties:

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

Acute Care Beds

The Council voted to remove previously identified bed needs from Buncombe and Hoke and to add a Need Determination for 20 beds in Cumberland. The resulting bed needs are:

  • 7 in Anson
  • 65 in Cabarrus
  • 20 in Cumberland
  • 6 in Duplin
  • 48 in Gaston
  • 164 in Mecklenburg
  • 25 in New Hanover
  • 23 in Scotland
  • 21 in Union
  • 44 in Wake

Vascular Access Operating Rooms

As an alternative to ad hoc Petitions for vascular access (VA) operating room (OR), the Council voted for Need Determinations for one dedicated ambulatory VA OR in each of the six (6) Health Service Areas (HSAs) in the state. 

The Agency’s Report indicated that VA ORs proposed pursuant to this Need Determination cannot be located in either Mecklenburg or Wake counties as there is a dedicated VA ASC with one (1) OR in each County. The VA OR can be located at an existing ASC or a proposed ASC, or on a hospital campus. If the OR is to be located at a hospital, it must be a dedicated ambulatory OR (i.e., in a hospital outpatient surgery department (HOPD)). The VA ORs will be limited to serving dialysis patients; CON-approved VA ORs and their procedures will be included in the standard OR planning inventory and methodology.

Operating Rooms

The Council voted for a Petition for an adjusted Need Determination for two (2) ORs in Johnston County and three (3) ORs in the Pitt/Greene/Hyde/Tyrrell service area. The Proposed State Plan will show no other OR Need Determinations. 

Dialysis Stations

The Agency did not recommend a pilot demonstration project for nursing home-based dialysis stations as requested by a Petitioner. As an alternative, the Council voted for a county Need Determination for six (6) outpatient dialysis stations at a nursing home facility in Mecklenburg County with the following stipulations:

  1. A licensed nursing home facility must propose to develop at least the minimum number of stations required for Medicare certification by CMS as a dialysis facility;

  2. The new stations must be sited within a nursing home facility or “proximate to the nursing home building,” i.e., on the same property as the nursing home facility;

  3. The dialysis facility must comply with the federal life safety and building code requirements applicable to a nursing home if located within it and the life safety and building code requirements applicable to dialysis facilities if located within the nursing home or “proximate to the nursing home building”;

  4. The CON will include a condition requiring the dialysis facility to document that it has applied for Medicare certification no later than three (3) years from the CON effective date;

  5. Dialysis stations developed pursuant to this Need Determination will be excluded from the planning inventory in the State Plan and excluded from the county and facility need methodologies; and

  6. Outpatient dialysis facilities developed pursuant to this Need Determination must report utilization to the Agency in the same manner as other outpatient dialysis facilities.

As stated above, any person may submit a CON application for this Need Determination.


The Council voted for PET Scanner Need Determinations for Health Service Areas I and II. Each of these Health Service Areas contains multiple Counties – Buncombe County and numerous Western North Carolina Counties comprise Area I; Forsyth and Guilford and surrounding Counties make up Area II. 

Nursing Facility and Adult Care Home Beds / Hospice Inpatient Beds

The Council recommended no need for new nursing homes and a need for only 30 adult care home beds in Anson, 40 in Perquimans, and 20 in Swain. Apart from these limited opportunities, as has been the case for years, providers seeking to add long-term care capacity will be relegated to acquiring existing beds. A need for eight (8) hospice inpatient beds was recommended for Cumberland County.

Psychiatric / Chemical Dependency Treatment Center Beds

The need methodologies for psychiatric and chemical dependency treatment center beds are no longer a State Plan feature; providers are free to apply for CON approvals without awaiting Need Determinations. Proposals are still subject to CON review, including the requirement to demonstrate need, but proposals can be filed in any County in accordance with the Review Schedule in the final State Plan.  

Cardiac Cath

Cardiac catheterization (Cardiac Cath) equipment can be approved for development on hospital sites or in licensed ambulatory surgical facilities (excluding endoscopy-only facilities).

In response to a Petition, the Council voted for an adjusted Need Determination for one shared fixed cardiac cath equipment unit in Burke County and one in Brunswick County. The Council voted to deny a Petition to remove the cardiac cath equipment need for New Hanover County. 

The Proposed State Plan will include Cardiac Cath equipment needs in Burke, Brunswick, Johnston, New Hanover, Orange, and Wayne Counties.


A linear accelerator (Linac) need was recommended for Service Area 14, which includes Chatham and Orange Counties. In addition, the Council voted for a Petition for an adjusted Need Determination for one new Linac for Service Area 20, which includes Wake and Franklin Counties.    

Other Health Care Capacities

As in prior years, the CON Law allows various proposals to be filed without a Need Determination. For instance, among other possibilities and depending on the proposal specifics, without a Need Determination: long-term care providers may apply to relocate nursing home or assisted living beds; surgery center proposals may be submitted based on OR relocations; diagnostic centers and endoscopy centers may be proposed; and endoscopy providers may apply to relocate and/or expand the rooms within existing centers. 

Again this year, legislative proposals and court decisions could shift the CON landscape. Even without such shifts, the year 2023 promises to be a busy one in North Carolina with varied opportunities across the health care delivery spectrum. 

Craddock Retirement

The State Health Coordinating Council’s final meeting for the year concluded with a robust round of applause and a tribute to Assistant Chief Dr. Amy Craddock for her years in leadership with Healthcare Planning. Dr. Craddock has announced her plans to retire at the close of the month.

For more information, please contact Joy Heath at (919) 981-4001 or