Certificate of Need (CON)

If you're planning to build, change, or add services to a health care facility, you can ask the Department of Health to decide whether you need a CON. This is called a Request for Determination (RFD).

You can submit a request if you're not sure whether:

• Your project costs will go over the dollar limit set in law.
• Your project would count as converting to a nursing home
• The work is just routine maintenance or a normal equipment replacement.
• Your facility counts as a “health care facility” under the law.

You’ll need to send:

• A clear and complete description of your project and everything it involves.
• A certified cost estimate for each part of the project.
• An estimated start and end date for the project.

The Department has twenty days to review your submitted request. If the Department needs more information, it will ask for the necessary information in writing. You will have 30 days to respond, or your request will be closed.

Once the Department has everything they need, they will send you a decision whether a CON is required within 20 days.

• If the Department decides that a CON is required, you’ll need to apply for and get a CON before starting your project. You can also ask for a reconsideration of the decision that a CON is required
• If the Department decides that a CON is not required, you may move forward with your project. However, if later your project costs go up or your plans change, you might still need to apply for a CON

Before you submit a CON application, you can ask the Department of Health to meet with you for a pre-application conference. This meeting is a chance to get help understanding the application process. The Department won’t help you fill out your application, but if they have helpful information, they can share it to support you as you prepare your application.

The Department is required by regulation 7 AAC 07.035 to schedule a pre-application conference if you ask for one. The Department can also choose to schedule a pre-application conference on its own, even if you don’t request it, to provide guidance and technical assistance regarding the application process.

Once you submit a CON application, here’s what you can expect:

1. The Department checks if your application is complete
   Within 30 days, the Department will tell you if your application is complete.
   1. If anything is missing, the Department will ask for more information.
   2. You’ll have 60 days to send the missing details, or your application will be denied.
2. A public notice is published
   Once your application is complete:
   1. The Department will publish a public notice in the newspaper and on the State of Alaska’s Online Public Notice System
   2. The notice will describe your project and include instructions for others to comment or apply to do a similar project in the same area (called a “concurrent review”)
3. Public comment and meeting
   
   1. The public has 30 days to share comments
   2. A public meeting will be held 15 to 30 days after the notice is published
   3. This is a chance for people to ask questions or raise concerns
4. Department review
   The Department will:
   
   1. Review your application based on relevant laws and the Alaska CON Review Standards and Methodologies, which are adopted by reference in regulations at 7 AAC 07.025 
      1. Important: The Alaska CON Review Standards and Methodologies gives the rules and math formulas DOH uses to determine if a new or expanded health care service is needed
   2. If other similar applications were received, they will be reviewed together in a “comparative review”
   3. The Department will write an analysis and recommendation for the Commissioner
5. Commissioner makes a decision
   The Department of Health’s Commissioner will make a final decision within 45 days of receiving the Department’s review.
   The decision will say, as applicable:
   1.  Whether your CON is approved or denied.
   2. The maximum amount you are allowed to spend on the project.
   3. The approved capacity of other services that are expanded or added.
   4. A completion date for the proposed project

   The decision is shared with the applicant, posted to the State of Alaska’s Online Public Notices page, published in the newspaper, and provided to anyone who asked to be notified. If your CON is denied or you disagree with the decision, you have 30 days to ask for an appeal or hearing

6. Public notice of the decision
   The Department will publish a public notice of the Commissioner’s decision and provide information on how to get a copy or appeal.
   Important:
   
   1. Once a CON is approved, it’s only valid for the timeframe listed in the certificate.
   2. Approval of a CON does not guarantee funding from Medicaid or any other state, federal, or private program.
   3. You must complete the project as described; changes may require further approval.

No. Once your project is completed or the final deadline on your CON has passed, you can’t request any changes. Make sure to submit any requests before your project is done or your certificate expires.

If you’re still working on your project and making progress, you can request a one-time extension of up to two years.

• Your request must be in writing
• You must explain why you need more time and give a new estimated completion date
• The Department can approve the new date if you are making ongoing progress

You can only do this once. Any later date changes require a full modification request. (See "How do I request a Modification?")

You must submit a modification request if:

• You’re changing the purpose or goal of the project.
• You already used your one-time extension and still need more time.
• You’re making design changes that will raise your operating costs by $250,000 or more.
• The total cost of the project will go up more than 15% over what was originally approved.

You must use the CON Request for Modification form from the Department and include:

1. A detailed description of each change and why it’s needed
2. The estimated cost increase (if any)
3. A current progress report

The Department will review your request and let you know in writing whether:

• No modification is needed.
• The change is small (a “minimal” change) and needs only a limited review.
• The change is big and needs a full review with a new CON application and fee.

The Department will do a limited review and give a recommendation to the Commissioner, who will then make a decision. Minimal changes are ones that:

• Do not change the services or purpose of the project, and
• Either reduce the cost or increase it by no more than 15%.

If the change is major, you must:

• Submit a new CON Application Packet
• Pay a new application fee

Important: While your new application is being reviewed, you can only keep working on the parts of your project that were already approved under your original CON.

Yes. The Department will publish a public notice of the Commissioner’s decision, following the usual public notice rules.

If someone has submitted a CON application and you want to apply for a similar project in the same area, you’ll need to submit a LOI to the Department of Health.

The LOI tells the Department that you’re planning to apply for a similar project. This lets the Department review your application at the same time as the original one. This is called a concurrent review.

Your letter must:

1. Clearly describe your proposed project and everything it includes
2. Include a certified estimate of how much each part of the project will cost
3. List the estimated start and end dates of the project

A LOI must be submitted in writing to the Alaska Department of Health.

By email to DOH.CON@alaska.gov

or

By mail to:

Alaska Department of Health
ATTN: Certificate of Need Program
3601 C Street, Suite 978
Anchorage, AK 99503

After you send the LOI, you’ll have 60 days (starting from when the original application is declared complete) to submit:

• Your full Certificate of Need application
• The required application fee
• A written agreement to participate in the statewide health reporting system

No. A CON is a separate process from health care facility licensure.

• You do not need a CON to get a facility licensed or certified
• You also do not need a license or certification to apply for a CON

However, some health care projects may require both a CON and a facility license, depending on the type of service being offered.

The CON Program does not handle facility licensing or certification. For State of Alaska licensing requirements, please visit the following pages:

• Residential Licensing (HCS)
• Health Facilities Licensing & Certification (HCS)
• Behavioral Health Licensing (DBH)

The Department recommends contacting both the CON Program and the appropriate licensing program early in your planning process to avoid delays.

If your CON application is denied (either fully or partly), you have the right to appeal that decision.

You must send a written request for a hearing.

•  It must be submitted within 30 days after the public notice of the decision is published.
• Your request must clearly explain why you are appealing the decision.

• A hearing officer will be assigned.
• The hearing will be based primarily on the information that was available when the Department made its original decision.
• You may present new evidence only if:
  
  • It was available but not properly considered before, or
  • It was unknown to both you and the Department at the time but is now available.

• You (the applicant)
• The Department of Health
• Any other applicants who were involved in a concurrent review (if there was one)

After the hearing, the hearing officer will make a recommendation to the Commissioner. The Commissioner can approve it, change it, send it back for more review, or reject it.

Yes. A hearing can also be requested to modify, suspend, or revoke an existing CON. This type of hearing may be requested by:

• The Department of Health
• Another CON applicant
• A member of the public who is affected by the approved project

This type of hearing must also be requested within 30 days of the public notice about the decision. It must follow legal rules for administrative hearings.

Hearing requests must be submitted in writing to the Alaska Department of Health. If you are requesting a hearing about a CON decision, your written request should be sent to the following address:

Alaska Department of Health
Office of the Commissioner
ATTN: CON HEARING REQUEST
P.O. Box 110601
Juneau, AK 99811-0601

You may also submit your request via email to DOH.CON@alaska.gov