Iowa requires CONs within five broad categories—hospital beds, beds outside hospitals, equipment, facilities and services. Iowa maintains 29 independent CON requirements and 18 separate exceptions, one of which is in the form of an attorney general opinion concluding that Iowa’s air ambulance CON provision conflicts with federal aviation law and thus is unenforceable. Despite the attorney general opinion from 2016, the air ambulance CON provision remains codified in Iowa’s statutes. Iowa also maintains a CON requirement for activities such as reducing bed capacity and eliminating a health service.

COVID-19 Response

On March 17, 2020, Governor Reynolds suspended the requirement that institutional health facilities obtain a CON prior to increasing bed capacity. Proclamation of Disaster Emergency Relief (Mar. 17, 2020). The suspension expired April 16, 2020.

Application Process

In Iowa, the CON application review process takes between 60–90 days. Iowa Code § 135.69(1); Iowa Admin. Code §§ 641- 202.7(3), (6). Applications can be submitted at any time. The fee for a CON application can range from $600 to $21,000. Iowa Admin. Code § 641-202.4(2). Competitors can intervene in the application process and can offer evidence or argument as to why an application should be denied. Iowa Code § 135.66(4).

CON? Number of CONs Moratoria Temporary COVID-19 response:
Hospital Beds Yes 1 Suspended at least some CON laws
Beds Outside Hospitals Yes 7 Suspended at least some CON laws
Equipment Yes 4 No action
Facilities/ Buildings Yes 8 No action
Services Yes 9 No action
Emergency Medical Transport No