South Carolina
South Carolina requires CONs within five broad categories—hospital beds, beds outside hospitals, equipment, facilities and services. The Department of Health and Environmental Control administers the CON program through a comprehensive state health plan issued at least once every two years. S.C. Code § 44-7-180(C); S.C. Code Regs. 61-15 § 106. South Carolina requires facilities to obtain a CON when offering any new service, yet it also requires facilities to obtain a CON when expanding a service at the cost of $2 million or more.
South Carolina’s COVID-19 Response
On March 19, 2020, Governor McMaster issued a robust executive order that broadly lifted requirements to allow healthcare facilities and providers to respond to the pandemic by, among other things: (1) converting non-traditional beds and spaces into areas for patient care without a CON and (2) purchasing equipment necessary to care for COVID-19 patients without a CON. Exec. Order 2020-11 (Mar. 19, 2020).68 The Department issued further guidance on the orders. S.C. Dep’t of Health and Envtl. Control, Exec. Order No. 2020-11, Section 4 Suspending Certain Aspects of Certificate of Need Review Frequently Asked Questions.69
Application Process
In South Carolina, the application process takes 30 to 150 days after an application is complete and affected parties have been notified of the application. S.C. Code § 44-7-210(A). The entire process from submission to approval typically takes much longer. Applications can be submitted at any time and the fee for a CON application is $500. S.C. Code § 44-7-200(A); S.C. Code Regs. 61-15 § 301. Competitors can intervene in the application process and can offer evidence or argument as to why an application should be denied. S.C. Code § 44-7-210(A), (E).
Types of CONs in South Carolina
| CON? | CON applies with expenditure of: | Temporary COVID-19 response: | |
| Hospital Beds | Yes | Any amount | Suspended |
| Beds Outside Hospitals | Yes | Any amount | Suspended |
| Equipment | Yes | $600,000+ | Suspended |
| Facilities/Buildings | Yes | Any amount | Suspended |
| Services | Yes | $0 – $2 million+ | Suspended |
| Emergency Medical Transport | No | – | – |
South Carolina CONs in Detail
| Category | Types of CONs | S.C. Code |
| Hospital Beds | The addition of one or more beds or change in the classification of licensure of one or more beds in: Acute care hospitals. Psychiatric hospitals. Alcohol and substance abuse hospitals. | §§ 44-7-160(2), 44-7-130(10), (12) |
| Obstetrical beds. | 2020 South Carolina Health Plan at 18-1970 | |
| Beds Outside Hospitals | The addition of one or more beds or change in the classification of licensure of one or more beds in: Nursing homes. Ambulatory surgical facilities. Hospice facilities. Radiation therapy facilities. Rehabilitation facilities. Residential treatment facilities for children and adolescents. Intermediate care facilities for persons with intellectual disability. Narcotic treatment programs. Any other facility for which CON review is required by federal law. | §§ 44-7-160(2), 44-7-130(10) |
| Equipment | Gamma knife. Linear accelerator. | 2020 South Carolina Health Plan at 87 |
| The acquisition of medical equipment which is to be used for diagnosis or treatment if the total project cost is in excess of $600,000. | § 44-7-160(6); S.C. Regs. 61-15 § 102(1)(f) | |
| Category | Types of CONs | S.C. Code |
| Facilities/Buildings | Construction or establishment of: Acute care hospital. Psychiatric hospital. Alcohol and substance abuse hospital. Nursing home. Ambulatory surgical facility. Hospice facility. Radiation therapy facility. Rehabilitation facility. Residential treatment facility for children and adolescents. Intermediate care facility for persons with intellectual disability. Narcotic treatment program. Any other facility for which CON review is required by federal law. | §§ 44-7-160(1), 44-7-130(10) |
| Services | Home health agency. | § 44-69-75 |
| Radiotherapy services. Cardiac catheterization. Neonatal intensive care services. Open heart surgery. | 2020 South Carolina Health Plan | |
| A capital expenditure by or on behalf of a health care facility in excess of $2 million or any capital expenditure which is associated with the addition or substantial expansion of a health service for which specific standards or criteria are prescribed in the South Carolina Health Plan. | §§ 44-7-160(3)-(4), 44-7-130(10); S.C. Ann. Regs. 61-15 § 102(1)(c)-(d) | |
| The offering of a health service by or on behalf of a health care facility which has not been offered by the facility in the preceding 12 months and for which specific standards or criteria are prescribed in the South Carolina Health Plan. | §§ 44-7-160(5), 44-7-130(10); S.C. Code Regs. 61-15 § 102(1)(e) | |
| Emergency Medical Transport | No CONs in this category. |
South Carolina CON Exceptions
| No CON Required For: | S.C. Code |
| Acquisition of medical equipment, offering an institutional health service or obligation of a capital expenditure solely for research if it does not: (1) affect the charges imposed other than for the services that are included in the research; (2) change the bed capacity of a health care facility; or (3) substantially change the services provided. | § 44-7-170(A)(1); S.C. Code Regs. 61-15 § 104(1)(b) |
| The offices of a licensed private practitioner whether for individual or group practice. | § 44-77-170(A)(2); S.C. Code Regs. 61-15 § 104(4) |
| The replacement of like equipment for which a Certificate of Need has been issued which does not constitute a material change in service or a new service. | § 44-77-170(A)(3); S.C. Code Regs. 61-15 § 104(1)(a) |
| Crisis stabilization unit facilities. | § 44-77-170(A)(4) |
| Expenditure by or on behalf of a health care facility for nonmedical projects. | § 44-77-170(B)(1); S.C. Code Regs. 61-15 § 105(5)(a) |
| Facilities owned and operated by the South Carolina Department of Mental Health and the South Carolina Department of Disabilities and Special Needs. | § 44-77-170(B)(2); S.C. Code Regs. 61-15 § 105(4)(d) |
| Educational and penal institutions maintaining infirmaries for the exclusive use of student bodies and inmate populations. | § 44-77-170(B)(3); S.C. Code Regs. 61-15 § 105(4)(c) |
| Any federal health care facility sponsored and operated by South Carolina’s state government. | § 44-77-170(B)(4); S.C. Code Regs. 61-15 § 105(4)(b) |
| Community-based housing designed to promote independent living for persons with mental or physical disabilities. | § 44-77-170(B)(5) |
| Kidney disease treatment centers. | § 44-77-170(B)(6) |
| Health care facilities owned and operated by the federal government. | § 44-77-170(B)(7); S.C. Code Regs. 61-15 § 105(4)(a) |
| The permanent reduction in bed capacity, including the permanent closure of a health care facility. | S.C. Code Regs. 61-15 § 104(1)(c) |
| Home health services provided by continuing care retirement communities. | § 44-69-75(B) |