Nebraska

Nebraska requires CONs within two broad categories – hospital beds and beds outside hospitals. Its CON laws apply only to long-term care and rehabilitation beds in hospitals, skilled nursing facilities, intermediate care facilities and nursing facilities. Nebraska also maintains moratoria on adding long-term care beds and rehabilitation beds. Neb. Rev. Stat. §§ 71-5829.04, 71-5829.06. Nebraska is one of only five states that do not allow competitors to intervene during the CON application process.  

Nebraska’s COVID-19 Response 

On March 31, 2020, Governor Ricketts suspended the CON requirements for long-term care and rehabilitation beds to permit hospitals to add and/or convert any beds to long-term care or rehabilitation beds. Exec. Order No. 20-12 (Mar. 31, 2020).⁵³ The order also suspended the existing moratoria on increasing long-term care beds and rehabilitation beds. The suspension was to remain in effect until 30 days after the lifting of the COVID-19 state of emergency. 

Application Process 

In Nebraska, the CON application process takes 60 days. Neb. Rev. Stat. § 71-5846. Applications can be submitted at any time. The nonrefundable fee for a CON application is $1,000. Neb. Rev. Stat. § 71-5837. The Nebraska CON law does not allow competitors to intervene in the application process or offer evidence or argument as to why an application should be denied. See Neb. Rev. Stat. § 71-5859. 

Types of CONs in Nebraska 

	CON?	CON applies with expenditure of:	Temporary COVID-19 response:
Hospital Beds	Yes	Any amount	Suspended
Beds Outside Hospitals	Yes	Any amount	Suspended
Equipment	No	–	–
Facilities/Buildings	No	–	–
Services	No	–	–
Emergency Medical Transport	No	–	–

 Nebraska CONs in Detail 

Category	Moratoria/Types of CONs	Neb. Rev. Stat
Hospital Beds	Moratorium on long-term care beds unless a listed exception applies.	§ 71-5829.04
	Moratorium on rehabilitation beds unless a listed exception applies.	§ 71-5829.06
	Initial establishment of long-term care beds, except as permitted by Neb. Rev. Stat. § 71-5829.03(4).	§ 71-5829.03(1)
	Initial establishment of rehabilitation beds, except as permitted by Neb. Rev. Stat. § 71-5829.03(5).	§ 71-5829.03(1)
	Increase in long-term care beds by more than 10 beds or more than 10% of the total long-term care bed capacity of the hospital, whichever is less, over a two-year period.	§§ 71-5829.03(2),  71-5803.06
	Increase in rehabilitation beds by more than 10 beds or more than 10% of the total rehabilitation bed capacity of the hospital, whichever is less, over a two-year period.	§§ 71-5829.03(3),  71-5803.06
	Any initial establishment of long-term care beds through conversion by a hospital of any type of hospital beds to long-term care beds if the total beds converted by the hospital are more than 10 beds or more than 10% of the total bed capacity, whichever is less, over a two-year period.	§ 71-5829.03(4)
	Any initial establishment of rehabilitation beds through conversion by a hospital of any type of hospital beds to rehabilitation beds if the total beds converted by the hospital are more than 10 beds or more than 10% of the total bed capacity, whichever is less, over a two-year period.	§ 71-5829.03(5)
	Any relocation of rehabilitation beds in Nebraska from one health care facility to another health care facility.	§§ 71-5829.03(6),  71-5803.06
Category	Moratoria/Types of CONs	Neb. Rev. Stat
Beds Outside Hospitals	Moratorium on long-term care beds unless a listed exception applies.	§ 71-5829.04
	Moratorium on rehabilitation beds unless a listed exemption applies.	§ 71-5829.06
	Initial establishment of long-term care beds. Initial establishment of rehabilitation beds.	§ 71-5829.03(1)
	Increase in long-term care beds in a skilled nursing facility by more than 10 beds or more than 10% of the total long-term care bed capacity, whichever is less, over a two-year period. Increase in long-term care beds in an intermediate care facility by more than 10 beds or more than 10% of the total long-term care bed capacity, whichever is less, over a two-year period. Increase in long-term care beds in a nursing facility by more than 10 beds or more than 10% of the total long-term care bed capacity, whichever is less, over a two-year period.	§§ 71-5829.03(2),  71-5803.06
	Increase in rehabilitation beds in a skilled nursing facility by more than 10 beds or more than 10% of the total rehabilitation bed capacity of the hospital, whichever is less, over a two-year period. Increase in rehabilitation beds in an intermediate care facility by more than 10 beds or more than 10% of the total rehabilitation bed capacity of the hospital, whichever is less, over a two-year period. Increase in rehabilitation beds in a nursing facility by more than 10 beds or more than 10% of the total rehabilitation bed capacity of the hospital, whichever is less, over a two-year period.	§§ 71-5829.03(3),  71-5803.06
	Any relocation of rehabilitation beds in Nebraska from one health care facility to another health care facility.	§§ 71-5829.03(6),  71-5803.06
Equipment	No CONs in this category.
Facilities/Buildings	No CONs in this category.
Services	No CONs in this category.
Emergency Medical Transport	No CONs in this category.

Nebraska is one of very few states that do not allow competitors to intervene during the CON application process. 

Nebraska CON Exceptions 

No CON Required For:	Neb. Rev. Stat.
Transfer or relocation of rehabilitation beds from a health care facility—a hospital, skilled nursing facility, intermediate care facility, or nursing facility—to another health care facility owned and operated by the same entity.	§§ 71-5829.03(6), 71-5803.06
Exception to the long-term care bed moratorium for unmet, complex or intensive medical and nursing needs.	§ 71-5829.04(1)(a)
Exception to the long-term care bed moratorium when all long-term care beds within 25 miles have averaged above 90% occupancy for 3 quarters.	§ 71-5829.04(1)(b)
Exception to the long-term care bed moratorium when all long-term care beds in a second-class city or village have been sold or transferred more than 25 miles away, and a local government or nonprofit agrees to develop and license a long-term care facility subject to a subsequent five-year moratorium on selling or increasing the bed capacity.	§ 71-5829.04(1)(b)
Exception to the rehabilitation bed moratorium when all rehabilitation beds statewide have averaged above 90% occupancy for 3 quarters.	§ 71-5829.06(1)
Exception to the rehabilitation bed moratorium when all rehabilitation beds in the health planning region have averaged above 80% occupancy for 3 quarters.	§ 71-5829.06(2)
A change in classification between an intermediate care facility, a nursing facility, or a skilled nursing facility.	§ 71-5830.01(1)
A project of a county in which is located a metropolitan city for which a bond issue has been approved by the electorate of the county on or after 1/1/94.	§ 71-5830.01(2)
A project of a federally recognized Indian tribe to be located on tribal lands within Nebraska where (1) the tribe’s governing body has made a determination that the cultural needs of the tribe’s members cannot be adequately met by existing facility, and (2) the tribe has a self-determination agreement with the Indian Health Service of the U.S. Department of Health and Human Services so that payment for enrolled members of a federally recognized Indian tribe who are served at such facility will be made with one hundred percent federal reimbursement.	§ 71-5830.01(3)
A transfer or relocation of long-term care beds from one facility to another entity in the same health planning region or any other health planning region.	§ 71-5830.01(4)