Maine

Maine

Maine requires CONs within five broad categories—hospital beds, beds outside hospitals, equipment, facilities and services. Maine’s CON program contains 42 independent CON requirements but exempts some commonly regulated services such as home healthcare and hospice. 10-144-503 Me. Code R. § 4-2(C), (D). Maine’s CON requirements allow providers to increase bed capacity without obtaining a CON if the increase is less than 10% of capacity. 10-144-503 Me. Code R. §§ 4-1(B)(5). The CON application fee can cost up to $250,000. 10-144-503 Me. Code R. § 6-8(A)-(D).

COVID-19 Response

On April 10, 2020, the Division of Licensing and Certification issued guidance allowing hospitals and nursing homes to apply for emergency CONs to increase bed capacity in response to the pandemic. Any approvals granted were temporary and expired 60 days after the Governor declared an end to the state of emergency.

Application Process

In Maine, the CON application process takes 90 days from the start of the review. 10-144-503 Me. Code R. § 7-1(B). Applications can be submitted at any time. The application fee is nonrefundable and it ranges from $5,000 to $250,000, calculated at $1,000 per $1 million in proposed capital expenditures. 10-144-503 Me. Code R. §§ 6-8(A)-(D). Competitors can intervene in the application process and offer evidence or argument as to why an application should be denied. 10-144-503 Me. Code R. § 6-6, see also § 7-1(C)(1)-(4). Applications that primarily involve maintenance of an existing healthcare facility may undergo a simplified review process. 10-144-503 Me. Code R. § 7-9.

CON? Number of CONs Moratoria Temporary COVID-19 response:
Hospital Beds Yes 2 – Expedited at least some CON reviews
Beds Outside Hospitals Yes 8 – Expedited at least some CON reviews
Equipment Yes 2 – No action
Facilities/ Buildings Yes 20 – No action
Services Yes 10 – No action
Emergency Medical Transport No – – –

Note: these citations are accurate as of May 2020.

Maine’s CON program contains 42 independent CON requirements, but exempts some commonly regulated services such as home healthcare and hospice.

Maine CONs in Detail

Category  

Types of CONs  

10-144-503 Me. Code R. 

Hospital Beds

An increase in the existing licensed bed complement or an increase in the licensed bed category greater than 10% in the following:

1.Hospitals.

2.Psychiatric hospitals. 

 § 4-1(B)(5); 

see Me. Rev. Stat. tit. 22,

§ 328(8)

Beds Outside Hospitals  

An increase in the existing licensed bed complement or an increase in the licensed bed category greater than 10% in the following:

1.Kidney disease treatment centers.

2.Ambulatory surgical facilities.

3.Recovery rooms within ambulatory surgical facilities.

4.Any space with major medical equipment within ambulatory surgical facilities. 

5.Any space used primarily to support the activities of an ambulatory surgical facility. 

6.Independent radiological service centers.

7.Cancer treatment centers.

8.Operating rooms within ambulatory surgical facilities. 

§ 4-1(B)(5); 

see Me. Rev. Stat. tit. 22,

§ 328(8)

Equipment  

1.The acquisition of major medical equipment costing more than $3,956,841, as updated annually.

§  4-1(B)(2); 

Me. Rev. Stat. tit. 22, 

§ 328(16) 

2.Any proposed use of major medical equipment to serve inpatients of a hospital, if the equipment is not located in a health care facility and was acquired without a CON.

§ 4-1(B)(7)(A) 

Facilities/Buildings 

1.Hospitals. 

2.Psychiatric hospitals. 

3.Nursing facilities. 

4.Kidney disease treatment centers. 

§ 4-1(B)(1); 

see Me. Rev. Stat. tit. 22,

§ 328(8)

Category  

Types of CONs  

10-144-503 Me. Code R. 

Facilities/Buildings

5.Ambulatory surgical facilities. 

6.Independent radiological service centers. 

7.Independent cardiac catheterization facilities. 

8.Cancer treatment centers. 

9.Operating rooms within ambulatory surgical facilities. 

10.Recovery rooms within ambulatory surgical facilities. 

11.Waiting areas for ambulatory surgical facility patients. 

12.Any space with major medical equipment within ambulatory surgical facilities. 

13.Any space used primarily to support the activities of an ambulatory surgical facility.

§ 4-1(B)(1); 

see Maine Rev. Stat. Ann tit. 22,

§ 328(8)

Capital expenditures made on behalf of one of the following facilities in excess of the stated expenditure minimum:

14.A capital expenditure on behalf of new or existing hospitals in excess of $12,365,130. Expenditure threshold is updated annually.

§ 4-1(B)(3)

15.A capital expenditure on behalf of nursing facilities in excess of $6,182,565. 

16.A capital expenditure on behalf of a new kidney disease treatment center in excess of $3 million. 

17.A capital expenditure on behalf of a new rehabilitation facility in excess of $3 million. 

18.A capital expenditure on behalf of a new ambulatory surgical facility in excess of $3 million. 

19.A capital expenditure on behalf of a new independent radiological service center in excess of $3 million. 

20.A capital expenditure on behalf of a new independent cardiac catheterization center or cancer treatment center in excess of $3 million. 

Me. Rev. Stat. tit. 22 §§ 329(3) (new or existing hospitals or other existing non-nursing facilities), 

329(6) (obligation on behalf of new or existing nursing facilities),

329(4-A)(B)(1) (other new facilities)

Services

1.Diagnostic services. 

2.Treatment services. 

3.Rehabilitative services.

4.Any new health service.

5.Nursing services. 

6.Alcohol and drug dependence treatment. 

7.Substance use disorder services. 

 § 4-1(B)(4);  

see Maine Rev. Stat. tit. 22 

§§ 328(8) (defining “health services”), 329(4)

8.Mental health services. 

§ 4-1(B)(7)(B); 

Me Rev. Stat. tit. 22

§ 328(17)(A)(B) 

9.Any expenditure by a nursing facility related to nursing services.

§ 4-1(B)(6)

10.Any health care service not subject to review initially, but which exceeds the expenditure minimum of $1,236,513 in the third fiscal year of operating, following the addition of that service. Expenditure threshold is updated annually.  

§ 4-1(B)(7)(B); 

Me Rev. Stat. tit. 22

§ 328(17)(A)(B)

Emergency Medical Transport  

  No CONs in this category.

 

Maine CON Exceptions

No CON Required For:   

10-144-503 Me. Code R.  

1.Facilities relying on healing through prayer. 

§ 4-2(A) 

2.Activities or acquisitions by or on behalf of a health maintenance organization or a health care facility controlled, directly or indirectly, by a health maintenance organization or combination of health maintenance organizations to the extent mandated by the National Health Policy, Planning and Resources Development Act of 1974, as amended, and its accompanying regulations. 

§ 4-2(B) 

3.Home health care services offered by a home health care provider. 

§ 4-2(C) 

4.Hospices. 

§ 4-2(D) 

5.Assisted living programs and services. 

§ 4-2(E) 

6.The use by an ambulatory surgical facility licensed on January 1, 1998 of capacity in existence on January 1, 1998. 

 § 4-2(F) 

7.Conversion by a critical access hospital of acute care beds to hospital swing beds. 

 § 4-2(G) 

8.Capital expenditures in the case of a natural disaster, major accident or equipment failure or for replacement medical equipment that is not major medical equipment defined in section 326, subsection 16. 

9.Capital expenditures for parking lots and garages, information and communications systems, or physician office space. 

10.Capital expenditures for projects directed solely at reducing energy costs through energy efficiency, renewable energy technology or smart grid technology and that have been certified as likely to be cost-effective by the Efficiency Maine Trust pursuant to Title 35-A, section 10122.  

Me. Rev. Stat. tit. 22, § 329(3)  

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