Kentucky is one of eight states to require CONs across all six broad categories—hospital beds, beds outside hospitals, equipment, facilities, services and emergency medical transportation. Kentucky maintains 45 independent CON requirements, although it also has 40 exceptions that apply to things like primary care centers, rural health clinics and most mobile clinics. See Ky. Rev. Stat. § 216B.020. The state failed to issue any formal guidance or otherwise suspend any CON requirements in response to COVID-19, but it maintains a general emergency CON regulation that allows for temporary expansions without CONs in limited circumstances.

COVID-19 Response

On March 6, 2020, Governor Beshear declared a state of emergency in Kentucky. Exec. Order 2020-215 (Mar. 6, 2020). In response, the Kentucky Cabinet for Health and Human Services (Cabinet) provided a brief update on its website regarding emergency CONs. See Cabinet, Certificate of Need. Notably, the Cabinet directed potential applications to “follow emergency regulation 900 [Ky. Admin. Regs.] 6:080.” This regulation allows healthcare providers to respond to the emergency without first seeking a CON, so long as they notify the Cabinet about what action was taken after the fact. The emergency service may continue without a CON until “the emergency ceases to exist” or “the [C]abinet issues a final decision to approve or disapprove the application for CON.” 900 Ky. Admin. Regs. 6:080 § 2(5). According to the Cabinet’s website, it received 25 emergency CON applications between March 18, 2020, and June 1, 2020. See Cabinet, CON Search Emergency Approval.

Application Process

In Kentucky, formal review of a CON application takes up to 90 days. Ky. Rev. Stat. §216B.015; 900 Ky. Admin. Regs. 6:065. If an application qualifies for nonsubstantive review and no direct competitors request a hearing, the application process takes 35 days once an application is deemed complete. See Ky. Rev. Stat. § 216B.095. Applications can be submitted at any time. The fee for a CON application ranges from $1,000 (for proposals less than $200,000 in capital expenditures) to $25,000 (for proposals greater than $5 million). 900 Ky. Admin. Regs. 6:020 §§ 1(2)-(4). An application fee is nonrefundable unless the applicant withdraws the application within five days after its submission. 900 Ky. Admin. Regs. 6:020 § 2(3). Competitors can intervene in the application process and can offer evidence or argument as to why an application should be denied. 900 Ky. Admin. Regs. 6:090.

CON? Number of CONs Moratoria Temporary COVID-19 response:
Hospital Beds Yes 3 Preexisting regulations
Beds Outside Hospitals Yes 14 Preexisting regulations
Equipment Yes 1 Preexisting regulations
Facilities/ Buildings Yes 17 Preexisting regulations
Services Yes 9 Preexisting regulations
Emergency Medical Transport Yes 1 Preexisting regulations

Note: these citations are accurate as of May 2020.

Kentucky CONs in Detail


Types of CONs

Ky. Rev. Stat.

Hospital Beds

1.Hospital beds.

2.Psychiatric hospital beds.

3.Physical rehabilitation hospital beds.

§§ 216B.061(1)(c),


Beds Outside Hospitals

1.Chemical dependency program

2.Nursing facilities.

3.Nursing homes.

4.Personal care homes.

5.Intermediate care facilities.

6.Family care homes.

7.Outpatient clinics.

8.Ambulatory care facilities.

9.Ambulatory surgical centers.

10.Emergency care centers.


12.Community mental health centers.

13.Home agencies.

14.Kidney disease treatment centers and freestanding hemodialysis units.

§§ 216B.061(1)(c),



1.The acquisition of major medical equipment that costs more than $3,319,893 as updated annually.

§§ 216B.061(1)(f),




2.Psychiatric hospitals.

3.Physical rehabilitation hospitals.

4.Chemical dependency programs.

5.Nursing facilities.

6.Nursing homes.

7.Personal care homes.

8.Intermediate care facilities.

9.Family care homes.

10.Outpatient clinics.

11.Ambulatory care facilities.

12.Ambulatory surgical centers.

13.Emergency care centers.


§§ 216B.061(1)(a),



Types of CONs

Ky. Rev. Stat.


15.Community mental health centers.

16.Kidney disease treatment centers and freestanding hemodialysis units.

§§ 216B.061(1)(a), 216B.015(13)

17.Any health facility that requests a capital expenditure in excess of $3,319,893, updated annually.

§§ 216B.020(4)(e),



1.Cardiac catheterization.

§ 216B.020(4)(b)(1)

2.Megavoltage radiation therapy.

§ 216B.020(4)(b)(2)

3.Adult day health care.

§ 216B.020(4)(b)(3)

4.Behavioral health services.

§ 216B.020(4)(b)(4)

5.Chronic renal dialysis.

§ 216B.020(4)(b)(5)

6.Birthing services.

§ 216B.020(4)(b)(6)

7.Home health services.

§§ 216B.061(1)(a), 216B.015(13)

8.Emergency services above the level of treatment for minor illnesses or injuries.

§ 216B.020(4)(b)(7)

9.Any health service that requests a capital expenditure in excess of $3,319,893 as updated annually. The expenditure minimum is updated annually.

§§ 216B.020(4)(e),


Emergency Medical Transport

1.Ambulance providers.

§§ 216B.061(1)(a),see 216B.015(13)

Kentucky CON Exceptions

No CON Required For:

Ky. Rev. Stat.

1.Primary care centers.

§§ 216B.020(3)(a),


2.Special health clinics.

§ 216B.020(3)(b)

3.Specialized medical technology services, unless providing a state health plan service.

§ 216B.020(3)(c)

4.Retail-based health clinics and ambulatory care clinics that provide nonemergency, noninvasive treatment of patients.

§ 216B.020(3)(d)

5.Ambulatory care clinics treating minor illnesses and injuries.

§ 216B.020(3)(e)

6.Mobile health services, unless providing a service in the state health plan.

§ 216B.020(3)(f)

7.Rehabilitation agencies.

§ 216B.020(3)(g)

8.Rural health clinics.

§ 216B.020(3)(h)

9.Off-campus, hospital-acquired physician practices.


10.Private offices and clinics of physicians, dentists and other practitioners of healing arts.

§ 216B.020(2)(a)

11.Office buildings built by or on behalf of a health facility for the exclusive use of physicians, dentists and other practitioners of the healing arts.

§ 216B.020(2)(b)

12.Outpatient health facilities that do not provide services in the facility after midnight and are exempt from CON and licensure under 216B.020(3).

§ 216B.020(2)(c)

13.Dispensaries and first-aid stations located within business or industrial establishments maintained solely for the use of employees, if the facility does not contain inpatient or resident beds for patients or employees who generally remain in the facility for more than 24 hours.

§ 216B.020(2)(d)

14.Establishments, such as motels, hotels and boarding houses, which provide domiciliary and auxiliary commercial services, but do not provide any health related services and boarding houses which are operated by persons contracting with the United States Department of Veterans Affairs for boarding services.

§ 216B.020(2)(e)

15.The remedial care or treatment of residents or patients in any home or institution conducted only for those who rely solely upon treatment by prayer or spiritual means in accordance with the creed or tenets of any recognized church or religious denomination and recognized by that church or denomination.

§ 216B.020(2)(f)

16.On-duty police and fire department personnel assisting in emergency situations by providing first aid or transportation when regular emergency units licensed to provide first aid or transportation are unable to arrive at the scene of an emergency situation within a reasonable time.

§ 216B.020(2)(g)

17.Abortion facilities as defined in Ky. Rev. Stat. § 216B.015.

18.Hospitals that do not seek or accept Medicare, Medicaid or other financial support from the federal government or any state government.

19.Assisted living residences.

20.Family care homes.

21.State veterans’ nursing homes.

22.Services provided on a contractual basis in a rural primary-case hospital.

§ 216B.020(1)

No CON Required For:

Ky. Rev. Stat.

23.Community mental health centers for services as defined in Ky. Rev. Stat. Chapter 210.

24.Rural health clinics.

25.Private duty nursing services operating as nursing pools.

26.Group homes.

27.Licensed residential crisis stabilization units.

28.Licensed free-standing residential substance use disorder treatment programs with 16 or fewer beds, but not including Levels I and II psychiatric residential treatment facilities or licensed psychiatric inpatient beds.

29.Outpatient behavioral health treatment, but not including partial hospitalization programs.

30.End stage renal disease dialysis facilities, freestanding or hospital based.

31.Swing beds.

32.Special clinics, including but not limited to wellness, weight loss, family planning, disability determination, speech and hearing, counseling, pulmonary care and other clinics which only provide diagnostic services with equipment not exceeding the major medical equipment cost threshold and for which there are no review criteria in the state health plan.

33.Non-clinically related expenditures.

34.Nursing home beds that shall be exclusively limited to on-campus residents of a certified continuing care retirement community.

35.Home health services provided by a continuing care retirement community to its on-campus residents.

36.The relocation of hospital administrative or outpatient services into medical office buildings which are on or contiguous to the premises of the hospital.

37.The relocation of acute care beds which occur among acute care hospitals under common ownership and which are located in the same area development district so long as there is no substantial change in services and the relocation does not result in the establishment of a new service at the receiving hospital for which a CON is required.

38.The redistribution of beds by licensure classification within an acute care hospital so long as the redistribution does not increase the total licensed bed capacity of the hospital.

39.Residential hospice facilities established by licensed hospice programs.

40.The following health services provided on site in an existing health facility when the cost is less than six hundred thousand dollars ($600,000) and the services are in place by December 30, 1991: psychiatric care where chemical dependency services are provided, level one (1) and level two (2) of neonatal care, cardiac catheterization and open-heart surgery where cardiac catheterization services are in place as of July 15, 1990.

§ 216B.020(1)