Digital Debut

Maine Eases Certificate of Need Requirements

States continue to work on reforming the rules

BY STEPHEN ABRESCH | APRIL 23, 2026

Maine recently passed a law that will make it easier to establish new healthcare facilities, including ASCs. Maine LD 1890 increased the monetary threshold that triggers the requirement for a certificate of need (CON) in the state. Beginning January 1, 2027, the capital expenditure threshold that prompts CON review for a new healthcare facility will be increased from $3 million to $7.5 million, with annual updates to the threshold to reflect changes in the medical care services group of the Consumer Price Index. The legislation became law without the governor’s signature on March 31.

Maine’s recent change joins other more noteworthy efforts to reform or repeal CON requirements at the state level. South Carolina and Tennessee both enacted legislations repealing CON requirements for ASCs in 2023 and 2024, and North Carolina created a new, CON-exempt ASC licensing category in 2023.

While those legislative efforts are in the past, work is ongoing in Tennessee to implement the CON repeal for ASCs, which does not take effect until December 1, 2027. When Tennessee enacted HB 2269 during the 2024 legislative session, the legislation contained specific requirements for what a post-CON landscape would look like in the state. Under the legislation, the state’s Health Facilities Commission (HFC) is required to adopt additional licensing rules for all “non-hospital ambulatory surgical treatment centers” licensed on or after December 1, 2027. A “non-hospital” ASCs is defined as a licensed ASC that is not hospital-based, i.e., not an affiliate of, or is controlled by, an acute care hospital. Tennessee’s law requires the adoption of specific ASC licensing requirements surrounding participation in Medicaid and charity care for these facilities. HFC must adopt rules that require: participation in the TennCare medical assistance program at volumes comparable to similarly situated hospital-based ambulatory surgical treatment centers; and provision of charity care that is comparable to similarly situated hospital-based ambulatory surgical treatment centers.

HFC recently began the process of promulgating these rules by convening a technical advisory group (TAG). TAGs are a routine, though not required, part of the rulemaking process in Tennessee, where a regulator convenes a group of stakeholders to gather information, feedback and suggestions before starting the official rulemaking process with the release of a proposed rule.

On February 27, HFC released a memorandum announcing the creation of a TAG “to provide relevant expertise that will set quality standards for certain health services.” While an accompanying document notes that “the scope of this work is limited to only what the Commission is authorized to implement,” per the enacting legislation, in addition to calling for nominations for the TAG, the HFC specified that the questions for consideration by the TAG include:

What types of regulations would improve quality of care for patients of the license type that are not currently in state law or rule?

For example, accreditation, staff training or internal policies.

How could compliance with these regulations be monitored by HFC in a cost-effective way?
Would these regulations require access to nonpublic data sources? If so, how could we gain access to that data?
How can we evaluate the success of these regulations?

Nominations for the TAG were due to HFC by April 1; the ultimate composition of the TAG is not yet publicly available as of April 20. Once the TAG has met and provided suggestions, HFC’s Office of Legal Services will begin official rulemaking, which is a months-long process. ASCA is tracking this process and will report on developments as the TAG delivers its recommendations and official rulemaking begins.

ASCA tracks developments around CON laws across the country. Write Stephen Abresch at sabresch@ascassociation.org with any questions.