Certificate of Need (CON)

Certificate of Need ("CON") is a review process that requires an application for, and receipt of, a certificate of need. Applications are submitted to the Department of Inspections, Appeals, & Licensing (DIAL) before offering or developing a new or changed health service. Potential applicants include hospitals, nursing facilities, ambulatory surgery centers or anyone purchasing medical equipment costing more than $1.5 million. Department staff and the State Health Facilities Council review proposed projects against criteria in the law.

The State Health Facilities Council is a five-member committee appointed by the Governor. The members each serve a six year term. Authority for the State Health Facilities Council is in the Code of Iowa Chapter 10A.711 - 10A.729. It is the Council's mandate to ensure that growth and changes in the health care system are orderly and cost effective, and that the system is adequate and efficient.

Go to the State Health Facilities Council page for more information.

Iowa Code Related to CON

Iowa Administrative Chapters Related to CON

Following are the dates of the scheduled meetings of the State Health Facilities Council and the accompanying deadlines for filing a letter of intent, an application for consideration or a reviewability determination. Remember, a letter of intent must be on file for a minimum of 30 days prior to filing an application. These documents are due by 4:00 p.m. on the appointed date.

Filing an application by the deadline is no guarantee that the application will be heard at that meeting. The completeness of the application and the number of applications on file will be factors. It is best to file an application as early as possible.

The Council will schedule additional meetings if needed. Please note that this schedule is subject to change.

Meeting and Submission Deadlines

Meeting and Submission Deadlines

Please note that all written materials and presentations are due by no later than 4 p.m. on the appointed date.

Please note that Letters of Intent are kept for one year after the date of submission or update.

Letters of Intent

Letters of Intent on File

There are no letters of intent currently on file.

CON applications that are currently on file awaiting review.

Applications on File

Guidelines for preparing letters of intent, affected party letters, and CON applications.

Affected Party Guidelines

  1. Affected persons (aka “affected party” or “affected parties”) are defined in Iowa Code section 135.61(1) (a-f). The appropriate geographic service area for affected parties is defined in IAC 641 chapter 202.1.
  2. An affected party may submit a letter of support or opposition to a specific project, appear at the meeting to provide oral testimony either in support or opposition, or both. An affected party is not required to submit written testimony in order to appear as an affected party at the meeting. Neutral letters can also be provided.
  3. Written submission of an affected party letter – including from the applicant - must be received no later than 4 p.m. by the deadline noted in the affected party memo sent by CON staff. These written submissions should be submitted by email to the CON program manager. The deadline is also noted under “Next Meeting - Submission Deadlines” on the CON web page. To assist State Health Facilities Council members in their review, all affected party materials, except exhibits, must be submitted by the deadline for affected party letters. Exhibits are due by the date listed in the affected party memo.
  4. Letters of support or opposition may be included in an exhibit (e.g., PowerPoint) in whole or in part, only if (1) the letter was submitted by the deadline established by the department, or (2) the author of the letter is present at hearing and will offer oral testimony regarding the letter.
  5. Affected party testimony at a CON hearing that simply duplicates written materials will not be heard.
  6. Affected party oral testimony should be relevant to the project. Personal/professional background information, unless it is a brief statement that directly relates to the project being supported or opposed (i.e., a professional title), is not considered relevant and should be avoided. In the interest of time, personal stories/testimony from patients/families should be very brief, concise, and directly relevant to the application.
  7. Individual affected parties appearing at the hearing will be asked to limit remarks to no more than three to four minutes. Depending upon how many persons appear as affected parties and the agenda for the day, this time may be restricted further or increased by the State Health Facilities Council Chair. Institutional affected parties (e.g., hospitals, nursing facilities, ASC’s) and their representative individuals may be given a time frame (i.e., a specific number of minutes) for their presentation by CON staff. This will be arranged with that specific institution as the agenda is being developed. Institutional affected parties will be responsible for keeping their testimony within the designated time frame
  8. Affected parties may be timed and asked by the State Health Facilities Council Chair to conclude remarks if they run too long or are not relevant to the project.
  9. Any dissatisfied party who is an affected person with respect to the application, and who participated or sought unsuccessfully to participate in the formal review procedure prescribed by section 135.66, may request a rehearing in accordance with chapter 17A and rules of the department. If a rehearing is not requested or an affected party remains dissatisfied after the request for rehearing, an appeal may be taken in the manner provided by chapter 17A. Notwithstanding the Iowa administrative procedure Act, chapter 17A, a request for rehearing is not required prior to appeal under section 17A.19.
  10. All affected party materials are considered public record and are available for public inspection, copying, and disclosure under Iowa Open Records Law – Iowa Code Chapter 22. Testimony of affected parties at the hearing is also considered public record.

Guidelines for Application Submission

PLEASE READ PRIOR TO COMPLETING AN APPLICATION

  1. Prior to completing an application, review Iowa Code Sections 135.61-135.83 and 641 Iowa Administrative Code (IAC) chapters 202 and 203. These materials will provide information about Certificate of Need (“CON”) and the application process.
  2. If the reviewability of a project is in question a Reviewability Determination may be requested prior to the submission of an application. See 641 IAC 202.3 for more information and/or contact CON staff.
  3. As set forth in Iowa Code section 135.65, the sponsor of a proposed new or changed institutional health service shall submit a Letter of Intent not less than 30 days prior to submitting the CON application. Letters of Intent expire one year from the date they are received by the Iowa Department of Inspections, Appeals, & Licensing. CON staff will issue a letter of response to the Letter of Intent. There will be additional directions in the response to the Letter of Intent. Read this response carefully and keep it for future reference.
  4. PLEASE NOTE: The Department of Inspections, Appeals, & Licensing (DIAL) Health and Safety Division reviews and approves all nursing facility and hospital bed increases prior to issuing a new or amended license. Notification to DIAL is highly recommended if you are submitting a CON application for a facility that will have a bed increase. Contact the DIAL Health and Safety Division for more information. Please note that as of July 1, 2023, there is a moratorium on new nursing facility beds until at least June 30, 2024.
  5. Please read and follow, as necessary, the Guidelines for Affected Parties.
  6. There are different application forms depending on the type of CON project. Please select the most applicable application. Not all items on each application will relate to a specific project. If you have questions about the CON process, which application to use or the applicability of any item on your project, contact CON program staff..
  7. The applicant shall be the entity to whom the nontransferable CON will be issued.
  8. An application will not be accepted if the information contained in the application materially differs from the information provided in the Letter of Intent (i.e., facility name; sponsor; capital expenditure; and location, including county).
  9. The applicant shall answer all questions on the applicable form. If a question is not relevant, indicate “not applicable” or N/A, and a brief explanation about why the applicant does not believe the information is required.
  10. Number the pages in your application.
  11. The applicant will file an electronic copy of the entire application (including any attachments) which must be received by the date/time noted in the response to the Letter of Intent. All applications must be received by no later than 4 P.M. on the due date. Late applications will be subject to the next new review cycle.
  12. The appropriate CON filing fee, as set forth in Iowa Code section 135.63 and as noted in the response to the Letter of Intent must be paid concurrently with the filing of the CON application. Make checks payable to: Treasurer, State of Iowa. PLEASE NOTE: ICF/ID’s and ICF/PMI’s are exempt from the CON filing fee.
  13. CON staff will review the application for completeness upon receipt. Within fifteen (15) days of acceptance, the application will be deemed complete, substantially incomplete, or a request for additional information will be issued.
  14. If an application is deemed to be substantially incomplete, it will be returned for amendment and may be subject to the next new review cycle.
  15. If a request for additional information is issued, responses to the questions must be made in writing and delivered electronically to rebecca.swift@dia.iowa.gov by the due date.
  16. Affected party letters in support that are submitted by an applicant are due by the affected party deadline. This date is earlier than the final written submission date.
  17. The applicant final submission date allows an applicant to respond to letters of opposition. PLEASE NOTE: To assist State Health Facility Council (“Council”) members, exhibits (except rebuttal exhibits), must be submitted by the final written submission deadline so that they can be provided in advance to the Council.
  18. An applicant may withdraw its application at any time without prejudice. Applicants must notify CON program staff in writing of such action – an email is sufficient. Application fees are subject to refund based on the schedule listed in 641 IAC 202.4(2)(d). It is the responsibility of the applicant to notify CON staff regarding to whom the refund check should be made and to where it should be sent.
  19. The application, other materials in the project file and any evidence offered at hearing are considered public record and are available for public inspection, copying, and disclosure under Iowa Open Records Law – Iowa Code Chapter 22.

Letter of Intent Guidlines

1. Before applying for a certificate of need (CON), the sponsor of a proposed new institutional service or changed institutional health service shall submit to the Department of Inspections, Appeals, & Licensing (“department”), Licensing Division, a letter of intent to offer or develop a service requiring a certificate of need.

2. Letters of intent must be submitted to the department not less than 30 days prior to the submission of an application for a CON.

  1. PLEASE NOTE: The Department’s Health and Safety Division reviews and approves all facility bed increases prior to issuing a new or amended license. If you will be submitting a CON application for a facility that will have a nursing facility or hospital license, notification to the department at the time the letter of intent is filed is highly recommended. Contact the DIAL Health and Safety Division for more information. In addition, nursing home beds have to be approved for compliance by the State Fire Marshal’s Office. Please contact them in advance of submitting your application to describe your project. *Please note that as of July 1, 2023, there is a moratorium on new nursing facility beds until at least June 30, 2024.

4. Letters of intent should be submitted as soon as possible after initiation of the planning process and before substantial expenditures are made.

5. Letters of intent shall include the following information:

Please note: A CON application may not be accepted if the information contained in the application materially differs from the information provided in the letter of intent (i.e., facility name; sponsor; capital expenditure; and location, including county).

6. Letters of intent are valid for one year from the date they are received by the department. The sponsor may renew the validity of a letter of intent by providing written notification to the department prior to the one-year expiration date.

7. A letter of intent should be sent via email – please provide in the letter a valid email for the primary contact person and his/her phone number.

8. Upon receipt of a letter of intent the department will issue a letter of response. Please keep this letter for further reference.

9. A list of active letters of intent is posted on the CON website.

10. For more information contact CON staff..