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Bill Summary · HB 409

Summary of HB 409 (2026 Regular Session, Kentucky) — Certificate of Need

Purpose and intent

  • This bill amends Kentucky’s Certificate of Need (CON) framework under KRS Chapter 216B. The overarching aim is to define terms more precisely, adjust thresholds for CON review, and clarify administrative processes related to establishing or expanding health facilities, services, and major medical equipment.

Key provisions and changes

  • Definitions (Section 1)

    • Refines numerous terms used in the CON program, including:
    • “Abortion facility,” “Ambulatory surgical center,” “Health facility,” “Health services,” and related concepts.
    • Thresholds for what constitutes a capital expenditure and the corresponding capital expenditure minimums.
    • “Major medical equipment” and the associated expenditure minimum.
    • “Substantial change in a health service,” “substantial change in bed capacity,” and “substantial change in a project” criteria.
    • Clarifies what constitutes a “certificate of need,” who qualifies as an “applicant,” and who is an “affected person.”
    • Establishes definitions for professionals (e.g., “Certified surgical assistant,” “Registered nurse first assistant”) and review processes (e.g., “Formal review process”).
    • Sets parameters for counting certain activities and including related costs in expenditure calculations (e.g., studies, plans, surveys, and related activities).

  • Certificate of Need thresholds and review (Section 2, KRS 216B.061)

    • Reiterates and clarifies actions that require a CON:
    • Establishing a health facility if costs exceed the capital expenditure minimum.
    • Making substantial changes in bed capacity or in health services if costs exceed the capital expenditure minimum.
    • Substantial changes in a project that would increase costs by more than 10%.
    • Acquiring major medical equipment above the major medical equipment expenditure minimum.
    • Altering a geographical area or designated location on an existing CON or license.
    • Transferring an approved CON for a new facility or replacement of an existing facility.
    • Prohibits evading expenditure minimums by splitting projects into separate components.
    • Addresses ex parte communications: prohibits ex parte contact with final decision-makers during the CON review cycle; if such contact occurs, it must be added to the record.
    • Requires CONs for ambulatory surgical centers (ASCs) and confirms that ASCs must obtain both CON and license, even if otherwise exempt under prior provisions.
    • States that, as of the effective date, certain existing ASCs licensed as of July 12, 2012, are not automatically exempt from CON for continued operation; rather, they retain rights as licensed facilities (clarifying transitional operations).

Who is affected

  • Healthcare providers and facilities:
    • Physicians’ offices and health facilities seeking to undertake major capital expenditures, establish new facilities, expand bed capacity, or add/alter health services.
    • Entities acquiring or transferring ownership or control of capital assets or facilities.
    • Ambulatory surgical centers and ASCs (explicit CON and licensing requirements apply).
  • Regulatory and reviewing bodies:
    • The Cabinet for Health and Family Services (CHFS) – continues to administer the CON process, with clarified definitions, thresholds, and procedures.
  • Patients and communities:
    • Affected persons (as defined in the bill) include individuals residing in the service area, facility users, local health facilities, and payors; changes in CON decisions may impact access, service availability, and costs in the health service area.

Procedural and timeline considerations

  • Review process:
    • Formal CON review process remains a 90-day timeline, with clarified criteria for what constitutes substantial changes and when CON is required.
    • The bill emphasizes “batch” review of related applications when appropriate (reviewing similar projects together for efficiency and consistency).
  • Compliance and enforcement:
    • Prohibits splitting a single project into multiple components to evade expenditure thresholds, ensuring project scope remains intact for CON purposes.
    • Ex parte contact prohibition underscores the integrity of the review process; any such contacts must be recorded.
  • Transition and exemptions:
    • Explicit treatment of existing ASCs licensed before a certain date, with a transitional approach to CON requirements, ensuring ongoing operations while aligning with new rules.

Overall impact

  • The bill strengthens and clarifies the CON framework by:
    • Tightening and standardizing expenditure thresholds (capital and major medical equipment) and what counts toward them.
    • Expanding definitions to better capture activities and entities subject to CON review.
    • Introducing safeguards against manipulation of project scope to avoid review.
    • Clarifying the treatment of ambulatory surgical centers and transitional provisions for pre-existing facilities.
    • Enhancing transparency and recordkeeping in the CON decision process through ex parte contact rules.

If you’d like, I can provide a side-by-side comparison with existing statute language or a concise one-page briefing for policymakers.

Compiled from official sources — confirm details with the bill’s official record.

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