New Jersey

New Jersey

New Jersey is one of eight states to require CONs within all six broad categories—hospital beds, beds outside hospitals, equipment, facilities, services and emergency medical transport. New Jersey’s CON program includes 100 distinct CON requirements, including one for paramedic services. N.J. Stat. §§ 26:2H-7, 26:2H-2(b); N.J. Admin. Code § 8:33-3.1. New Jersey and the District of Columbia are the only jurisdictions to require such a CON. Unlike most other states, New Jersey limits the number of applications which may be submitted by pre-determining the need for projects each year. N.J. Admin. Code § 8:33-4.1. Despite New Jersey’s robust CON program, it maintains only one equipment CON for cardiac catheterization equipment costing more than $ 2 million. See N.J. Stat. § 26:2H-7(c); N.J. Admin. Code §§ 8:33-1.3.

COVID-19 Response

On March 9, 2020, Governor Murphy issued an Executive Order declaring a state of emergency, which empowered the Department of Health to take any steps necessary to eliminate barriers to medical care. Exec. Order No. 103 (Mar. 9, 2020). On March 14, 2020, the Department responded by issuing a guidance regarding temporary operational waivers to allow hospitals to add additional beds without first obtaining a CON. Dep’t of Health, Temporary Operational Waivers during a State of Emergency (Mar. 13, 2020). After the state of emergency ends, facilities must return to their pre-emergency capacity.

Application Process

In New Jersey, the CON application process takes between three and nine months, depending on whether the project must go through “full review” or “expedited review.” N.J. Admin. Code § 8:33-4.1(a)–(b). The Commissioner of Health, who makes the final decision to approve or disapprove applications, receives recommendations from both Department of Health staff and the State Health Planning Board for applications under full review and from just the Department of Health for applications under expedited review. N.J. Stat. § 26:2H-5.8(b); N.J. Admin. Code § 8:33-4.1(b). Applications may only be submitted according to the schedule, published yearly by the Commissioner, which identifies the services and geographic areas projected to need additional providers over the next two years. N.J. Admin. Code § 8:33-4.1(a). The fee for a CON application is $7,500, plus 0.25% of the total cost for projects costing more than $1 million. N.J. Admin. Code § 8:33-4.3(b). Competitors generally cannot intervene in the application process. Except in limited circumstances, there are no public hearings prior to the Commissioner’s decision. N.J. Stat. § 26:2H-5.8(c).

CON? Number of CONs Moratoria Temporary COVID-19 response:
Hospital Beds Yes 10 – Suspended at least some CON laws
Beds Outside Hospitals Yes 35 – Suspended at least some CON laws
Equipment Yes 5 – No action
Facilities/ Buildings Yes 29 – No action
Services Yes 20 – No action
Emergency Medical Transport Yes 1 – No action

Unlike most other states, New Jersey limits the number of applications which may be submitted by predetermining the need for projects each year

New Jersey CONs in Detail

Category

Types of CONs

Citation

Full Review

Hospital Beds

Any increase or conversion of beds by licensure and/or health planning in:

1.General hospitals.

2.Special hospitals.

3.Mental hospitals.

4.Tuberculosis hospitals.

5.Chronic disease hospitals.

6.Maternity hospitals.

N.J. Admin. Code § 8:33-3.4(a)(1)–(2); N.J. Stat. § 26:2H-2(a)

7.Increasing the number of intermediate or intensive bassinets.

N.J. Admin. Code § 8:33C-1.4(b)(4)

8.Conversion of residential health care beds to long-term care beds.

N.J. Admin. Code § 8:33H-1.13(b)

9.Conversion of specialized care beds to general long-term care beds (or to any other specialized care use).

N.J. Admin. Code § 8:33H-1.13(f)

10.Conversion of acute care hospital beds to general or specialized long-term care beds.

N.J. Admin. Code § 8:33H-1.13(g)

Expedited Review

Beds Outside Hospitals

Relocation of some or all of a facility’s beds licensed for a particular service from one facility to another within the same planning region, including:

1.General hospitals.

2.Special hospitals.

3.Mental hospitals.

4.Tuberculosis hospitals.

5.Chronic disease hospitals.

6.Maternity hospitals.

N.J. Admin. Code § 8:33-3.4(a)(3); N.J. Stat. § 26:2H-2(a)

7.Addition of beds to long-term acute care hospitals.

N.J. Admin. Code § 8:33F-2.3(a)

Category

Types of CONs

Citation

Full Review

Beds Outside Hospitals

Any increase or conversion of beds by licensure and/or health planning category in:

8.Public health centers.

9.Diagnostic centers.

10.Treatment centers.

11.Rehabilitation centers.

12.Extended care facilities.

13.Skilled nursing homes.

14.Nursing homes.

15.Intermediate care facilities.

16.Assisted living residences.

17.Comprehensive personal care facilities.

18.Outpatient clinics.

19.Home health care agencies.

20.Residential health care facilities.

N.J. Admin. Code § 8:33-3.4(a)(1)–(2); N.J. Stat. § 26:2H-2(a)

21.Conversion of residential health care beds to long-term care beds.

N.J. Admin. Code § 8:33H-1.13(b)

22.Conversion of specialized care beds to general long-term care beds (or to any other specialized care use).

N.J. Admin. Code § 8:33H-1.13(f)

Expedited Review

Beds Outside Hospitals

Relocation of some or all of a facility’s beds licensed for a particular service from one facility to another within the same planning region, including:

23.Public health centers.

24.Diagnostic centers.

25.Treatment centers.

26.Rehabilitation centers.

27.Extended care facilities.

28.Skilled nursing homes.

29.Nursing homes.

30.Intermediate care facilities.

31.Assisted living residences.

32.Comprehensive personal care facilities.

33.Outpatient clinics.

34.Home health care agencies.

35.Residential health care facilities.

N.J. Admin. Code § 8:33-3.4(a)(3); N.J. Stat. § 26:2H-2(a)

Category

Types of CONs

Citation

Expedited Review

Equipment

1.Addition of cardiac catheterization equipment exceeding $2 million (other than by a general hospital licensed to provide full service invasive cardiac diagnostics).

N.J. Stat. § 26:2H-7(c); N.J. Admin. Code §§ 8:33-1.3, 8:33-3.7(a)

Type of Review Unspecified

2.Computerized axial tomography.

3.Magnetic resonance imaging.

4.Positron emission tomography.

5.Ventilator beds.

Facility Types57

Full Review

(if cost exceeds $2 million for the construction of new facilities)

Facilities/Buildings

1.General hospitals, including voluntary closure and transfer of ownership.

N.J. Stat. §§ 26:2H-7, 26:2H-2(a); N.J. Admin. Code §§ 8:33-3.2(b),

8:33-3.3(a)(1)

2.Special hospitals.

3.Mental hospitals.

4.Public health centers.

5.Diagnostic centers.

6.Treatment centers.

7.Rehabilitation centers.

8.Extended care facilities.

9.Skilled nursing homes.

10.Nursing homes.

11.Intermediate care facilities.

12.Tuberculosis hospitals.

13.Chronic disease hospitals.

14.Maternity hospitals.

15.Outpatient clinics.

16.Dispensaries.

17.Home health care agencies.

18.Residential health care facilities.

19.Dementia care home.

20.Bioanalytical laboratories owned by one of the facilities above.

N.J. Stat. §§ 26:2H-7, 26:2H-2(a)

Category

Types of CONs

Citation

Full Review

Facilities/Buildings

21.Transfer ownership of a hospital that will result in a new Medicare provider number for the hospitals involved.

N.J. Admin. Code § 8:33-3.3(a)(2)

22.Establishment of a maternal and child health consortium.

N.J. Admin. Code § 8:33C-1.4(a)

23.Regional cardiac surgery centers.

N.J. Admin. Code § 8:33E-2.14

24.Long-term acute care hospitals.

N.J. Admin. Code § 8:33F-2.3(a)

Expedited Review

Facilities/Buildings

25.Relocation of an entire health facility (other than a general hospital) to a location within the same planning region, provided it does not add beds or services and services at the original location cease.

N.J. Admin. Code § 8:33-3.5(a)(4)

26.Assisted living residences.

N.J. Admin. Code § 8:33H-1.7(a)

27.Comprehensive personal care homes.

N.J. Admin. Code § 8:33H-1.10(b)

28.Restricted admissions facilities.

N.J. Admin. Code § 8:33H-1.11(a)–(b)

Type of Review Unspecified

29.Ambulatory surgical centers.

Facility Types

Full Review

Services

1.Nursing service.

2.Home care nursing.

3.Paramedical service.

4.Service provided by an intern, resident in training, or physician employed by the facility.

5.Laboratory service.

6.Medical social service.

N.J. Stat. § 26:2H-7, 26:2H-2(b); N.J. Admin. Code § 8:33-3.1

7.Change in a hospital’s membership in a maternal and child health consortium.

N.J. Admin. Code § 8:33C-1.4(b)(1)

8.Hospital’s establishment of new services as a regional perinatal center, community perinatal center-intensive, and community perinatal center-intermediate.

N.J. Admin. Code § 8:33C-1.4(b)(2)

9.Hospital changing its perinatal designation to regional perinatal center, community perinatal center-intensive, and community perinatal center-intermediate.

N.J. Admin. Code § 8:33C-1.4(b)(3)

Category

Types of CONs

Citation

Expedited Review

Services

10.Establishment of new perinatal services as a community perinatal center-basic.

N.J. Admin. Code § 8:33C-1.4(c)(1)

11.Establishment of new perinatal services as a community perinatal center-birth center.

N.J. Admin. Code § 8:33C-1.4(c)(2)

12.Initiation of full service invasive cardiac diagnostic services (including converting low-risk invasive cardiac diagnostic services).

N.J. Admin. Code §§ 8:33E-1.11,

8:33E-1.15

13.Assisted living program.

N.J. Admin. Code § 8:33H-1.7(b)

Type of Review Unspecified

Services

14.Pediatric long-term care.

N.J. Admin. Code §§ 8:33H-1.1(c)(3),

8:33H-1.5

15.Specialized care program.

N.J. Admin. Code § 8:33H-1.6

16.Kidney, liver, or pancreas transplantation services.

N.J. Admin. Code § 8:33Q-1.1

17.Mobile intensive care.

N.J. Admin. Code § 8:41-9.2

18.Advanced life support.

N.J. Admin. Code § 8:41-9.2(c)

19.Lithotripsy.

20.Megavoltage radiation oncology services.

Facility Types

Full Review

Emergency Medical Transport

1.Ambulance service.

N.J. Stat. §§ 26:2H-7, 26:2H-2(b); N.J. Admin. Code § 8:33-3.1

New Jersey CON Exceptions

No CON Required For:

Citation

1.Community-based primary care centers

2.Outpatient drug and alcohol services

3.Hospital-based medical detoxification for drugs and alcohol

4.Ambulance and invalid coach services

5.Mental health services which are non-bed related outpatient services

6.Residential health care facility services (but residential health care facilities require a CON)

7.Dementia care homes

8.Capital improvements and renovations to health care facilities

9.Additions of medical/surgical, adult intensive care and adult critical care beds in hospitals

10.Inpatient special psychiatric beds used solely for patients with co-occurring mental health and substance abuse disorders

N.J. Stat. § 26:2H-7a

11.Addition (by a general hospital licensed to provide full service invasive cardiac diagnostic) or replacement of existing “major moveable equipment” (defined as cardiac catheterization equipment)

N.J. Admin. Code

§ 8:33-3.7(b)–(c);

N.J. Stat. § 26:2H-7(c)

12.Acquisition, replacement, expansion, or transfer of minor medical equipment (defined as anything other than cardiac catheterization equipment)

13.Inpatient operating rooms

N.J. Admin. Code

§§ 8:33-1.3, 8:33-3.8;

N.J. Stat. § 26:2H-7(a)

14.Alternate family care programs

15.Hospital-based subacute care

16.Ambulatory care facilities

17.Comprehensive outpatient rehabilitation services

18.Special child health clinics

19.Health care equipment that involves new technology not identified in the regulations

20.Transfer of ownership interest (except in the case of an acute care hospital)

21.Change of site for approved CON within same county

22.Additions to vehicles or hours of operation of a mobile intensive care unit

23.Replacement or relocation of a health care facility within the same county (other than an acute care hospital)

24.Continuing care retirement communities

25.Magnetic resonance imaging

26.Adult day health care facilities

27.Pediatric day health care facilities

28.Chronic or acute renal dialysis facilities

29.Transfer of ownership of a hospital to an authority

30.Extracorporeal shock wave lithotripter (to treat kidney stones)

N.J. Stat. § 26:2H-7a

No CON Required For:

Citation

31.Hyperbaric chamber

32.Positron emission tomography (PET scan)

33.Residential drug and alcohol services

34.Ambulatory surgical services

35.Basic obstetric and pediatric services and birth centers, including additions of basic obstetric and pediatric beds in hospitals

36.Linear accelerator

N.J. Stat. § 26:2H-7c

37.New technology, not covered by regulation, which meets certain standards

N.J. Stat. § 26:2H-7d

38.Increasing the total number of licensed beds at a nursing home by 10 or fewer beds or 10% or less of the bed capacity, whichever is less, within a period of five years

N.J. Stat. § 26:2H-7.2

39.Nursing homes affiliated with a “well established religious body or denomination” that reserve at least 65% of its licensed bed capacity for patients who are members of that religious body or denomination

N.J. Stat. § 26:2H-7.3

40.Services provided by a physician in a private practice

N.J. Stat. § 26:2H-2(b)

41.Practitioners of “healing solely by prayer”

N.J. Stat. § 26:2H-2(a)–(b)

42.Bioanalytical laboratories not owned by a health care facility

N.J. Stat. § 26:2H-2(a)

43.Services provided by first aid, rescue, and ambulance squads regulated by the New Jersey Highway Traffic Safety Act of 1987

N.J. Stat. § 26:2H-2(b)

44.Discontinuance of a component service of a health care facility or satellite emergency department, that is not required for an inpatient health care facility, as long as it does not decrease access to the population it serves

N.J. Admin. Code § 8:33-3.2(c)

45.Transfer of ownership of operating health care facilities, beds, services, or equipment (unless a general hospital or a transfer that will result in a new Medicare provider number)

N.J. Admin. Code

§ 8:33-3.3(a)-(b)

46.Any decrease in the number of licensed beds by licensure and/or health planning category

N.J. Admin. Code

§ 8:33-3.4(a)(2)

47.Replacement at the same site of an existing health care facility (other than a general hospital) that already has a CON, provided the replacement does not add beds or services not previously offered and the existing facility ceases operations

N.J. Admin. Code

§ 8:33-3.5(a)(2)

48.A new CON is not needed when the total cost of a project exceeds initial estimates (but fees and penalties may be imposed)

N.J. Admin. Code § 8:33-3.9(a)

49.Research projects for the duration of the investigational study or scientific research

N.J. Admin. Code

§ 8:33-3.11(a)–(b)

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