Conning the Competition

Minnesota strictly limits healthcare growth through the use of moratoria. Minnesota’s moratoria apply within two broad categories—hospital beds and facilities/building. Minnesota does not have a traditional CON program. Instead, it allows narrow exceptions to its existing moratoria through a “public interest review” (PIR) program. See Minn. Stat. § 144.552. For this reason, some have deemed Minnesota a “quasi-CON” state. To initiate the PIR process, an applicant must submit a plan illustrating, among other things, that a need exists for a prohibited facility. See Minn. Stat. § 144.552. PIR applicants must include their competitors’ positions with their initial application. Minn. Stat. § 144.552(f). The Department of Health reviews those applications and may make changes before recommending action by the full Minnesota Legislature. See sidebar on p.87.

COVID-19 Response

As of May 15, 2020, Minnesota had not suspended any PIR requirements in response to COVID-19.

Application Process

In Minnesota, anyone interested in obtaining a license to operate a new hospital or expand beds in an existing hospital must submit a plan to obtain an exception to the state’s moratorium. Minn. Stat. § 144.552. The plan must address: (1) whether a new hospital or new beds are necessary to provide access to care or improve services; (2) the financial impact of a new hospital or new beds; (3) how existing hospitals would be affected; (4) whether proposed services would be available to nonpaying or low-income patients; and (5) the views of affected parties. Minn. Stat. § 144.552(c)(1)-(5). The PIR process takes up to 150 days, during which time the Department takes an active role in suggesting adjustments to the plan. The Department then makes a recommendation to the Minnesota Legislature. That recommendation can be different than what the original applicant asked for. Minn. Stat. § 144.552(c). Applications can be submitted at any time and there is no application fee. A public hearing is required before an application is approved or rejected, and competitors can offer evidence and testimony as to why the PIR application should be rejected. Minn. Stat. § 144.552(f).