Last updated: November 2026
An Illinois Health Facilities and Services Review Board application is the filing a sponsor makes under the Illinois Health Facilities Planning Act, 20 ILCS 3960 (the Act), to obtain the permit or exemption that section 5 requires: no person shall construct, modify or establish a health care facility or acquire major medical equipment without first obtaining a permit or exemption from the State Board.
Integral Healthcare Solutions (IHS) drafts the application narrative, worksheets, exemption packet and review calendar; the sponsor files. This work sits in Compliance Services.
What is an Illinois Review Board permit application?
According to the Board's Certificate of Need program page, a permit requires the sponsor to justify that the project is needed and financially and economically feasible, in addition to satisfying the other criteria in the Board's rules, and exemptions are not based on need.
We read sections 3, 5, 6, 8.5, 10, 13.1 and 14.1 of the Act and 77 Illinois Administrative Code Part 1110, Part 1120 and Part 1130 (pages opened November 6, 2026). Each section header reads "scheduled to be repealed on December 31, 2029".
Who needs it: does the project need a permit or an exemption?
A project needs a permit or exemption when it involves a covered facility and meets a section 5 trigger. The Board's page lists covered entities, including hospitals, long-term care facilities, dialysis centers, ambulatory surgery centers, alternative health care delivery models, freestanding emergency centers and birthing centers, and says facilities operated by the federal government are not subject to the Act. It also lists adding a category of service as a permit project.
Section 5 requires a permit or exemption before major medical equipment is acquired, or a facility is constructed or modified, where the work:
- requires a total capital expenditure in excess of the capital expenditure minimum;
- substantially changes the scope or changes the functional operation of the facility; or
- changes bed capacity by increasing the total number of beds, by distributing beds among categories of service, or by relocating beds from one site to another by more than 20 beds or more than 10% of total bed capacity as defined by the State Board, whichever is less, over a 2-year period.
As of July 1, 2026, the Board's page gives the minimums as 18,321,164 dollars for hospitals, 10,355,430 dollars for long-term care facilities and 4,779,437 dollars for all other applicants, with the same thresholds for major medical equipment. Notwithstanding any other provision of the Act, no permit or exemption is required for the construction or modification of a non-clinical service area of a health care facility (section 5).
Change of ownership and discontinuation of a category of service are eligible for an exemption rather than a permit, other than a facility maintained by the State or a nursing home maintained by a county (section 6(b)); the Board's page also lists closure, and says long-term care facilities need no permit or exemption to close or change ownership but must report the transaction. Under rule 1130.410, a change of ownership or a discontinuation is outside the permit requirement only if an exemption application is submitted and the Board issues the exemption.
How does the Board decide, and how long is review?
Section 6(d) has the Board approve a permit if it finds the applicant fit, willing and able to provide a proper standard of care; economic feasibility demonstrated; safeguards assuring consistency with the public interest; and consistency with orderly, economic development and with the standards, criteria or plans of need adopted under section 12.
Within 10 business days after receiving an application for permit, Board staff decide whether it is substantially complete. It is deemed complete if all 14 listed items are met and incomplete if any is missing; the applicant then has 45 days after notification to complete it, or the application is declared null and void and fees paid are forfeited (1130.620(b)(3), (4), (8)).
| Step | Rule text |
|---|---|
| Staff review | At least 30 days after the completeness date; not more than 60 days for non-substantive or 120 days for substantive projects. Establishing or discontinuing a category of service is reviewed by the Board within 60 days, and a related-person change of ownership is acted on by the Board Chair within 45 days under the rule as now written (see January 1, 2027 below), unless the Chair requests Board review for a conflict of interest or other good cause. |
| Board action | Applications other than emergency applications are acted on at the next regular meeting at least 10 business days after staff review ends; the staff report is public at least 14 calendar days before it (1130.610(b); section 6(c-5)). |
What happens after approval, or if a project starts without one?
The holder of a permit files annual progress reports within 30 days before or after each anniversary of the Board's approval until completion, and a final completion and cost report within 90 days after the approved completion or extension date (section 5). For a project with a cost, the holder must spend or commit at least 33% of project cost within 24 months for major construction, 12 months otherwise, or by the completion date if earlier (1130.720).
Section 14.1(b)(4) allows a fine of up to twenty-five thousand dollars, plus the same amount for each 30-day period or fraction of one that the violation continues, for constructing, modifying, establishing or changing ownership of a facility without first obtaining a permit or exemption. Under section 13.1, a person who establishes, constructs or modifies a facility without a required permit, or in violation of its terms, cannot apply for necessary operating licenses, or receive State payment for services in that facility, until the permit is obtained.
What changes on January 1, 2027?
P.A. 104-557 also prints new texts of sections 3, 5, 6 and 10, effective January 1, 2027. Section 5 ties a permit to a street address or legal description, and section 10 has a hearing request served on the Chairman or the Agency. Section 8.5 prints three texts. The P.A. 103-526 text, in force now, says its changes are inoperative on and after January 1, 2027. The P.A. 104-557 and P.A. 104-782 texts are each marked effective that date and differ: for a related-person change of ownership, the first has the State Board act at the next meeting after the application is deemed complete, and the second has the Board Chair act within 45 days unless the Chair requests Board review for a conflict of interest or other good cause, in each case provided the application meets the applicable standards.
How IHS helps
- Trigger check. IHS sets the project against section 5, the posted thresholds and the exemption categories.
- Criteria map and drafting. IHS maps each review criterion to a narrative section and drafts the narrative, worksheets, exemption packet and attachment checklist.
- Calendar. IHS builds the review and reporting calendars and a hearing outline.
The sponsor supplies the project facts, capital estimate, two verifying officers, the filing, the Board's fees and attendance at the meeting. The real limit: IHS does not file with, call or correspond with the Board, and it does not predict a decision. Rule 1130.225 lets an applicant request technical assistance from Board staff; the sponsor makes the request.
What to have ready
- Illinois Secretary of State good-standing documentation for each applicant that holds the license and will operate the facility or, if not required to register in Illinois, evidence of authorization to do business in other states (1130.620(b)(3)(G)).
- The Safety Net Impact Statement, except for skilled and intermediate long-term care facilities licensed under the Nursing Home Care Act (1130.620(b)(3)(A)).
- Adverse actions in the three years before filing, pending litigation, and earlier projects' reports and Board questionnaires (1130.620(b)(3)(D), (E), (H)-(J)).
- The purpose and alternatives write-ups (1110.110) and the funds and financing evidence (1120.120; 1120.140).
- The fee, paid within 30 days of notice of the amount due (1130.230(d)), and two verifying officers (section 6(c)).
If the alternatives write-up or financing evidence does not exist yet, book the free introductory call below before a filing date is set.
How it compares
A permit turns on need, feasibility and the Board's criteria; an exemption is approved when the required information is submitted.
What it costs
Under rule 1130.230, a permit application carries an initial fee of five thousand dollars, and the full amount is set when it is deemed complete: five thousand dollars below two million two hundred fifty thousand dollars of estimated project cost, and 0.22% of project cost at or above that, never more than one hundred fifty thousand dollars. Exemptions carry five thousand dollars, except that a change of ownership other than among related persons carries the greater of five thousand dollars or 0.22% of the transaction's fair market value, capped at one hundred fifty thousand dollars. Projects classified as emergency carry no application fee. Verify current fees with the Board.
Consulting scope depends on the criteria narratives needed, existing modeling, permit versus exemption, and project size. IHS scopes each engagement after a free introductory call.
What this is not
This is not legal advice. IHS is a consulting firm, not a law firm; counsel decides whether a permit or exemption is required, which section 8.5 text governs, and any hearing or appeal. IHS does not act for you with the Board, and it does not guarantee a decision.
Frequently asked questions
When does an Illinois project need a Review Board permit?
Section 5 requires a permit or exemption before major medical equipment is acquired, or a facility built or modified, if the work exceeds the capital expenditure minimum, substantially changes scope or functional operation, or changes bed capacity as section 5 describes.
What is the difference between a permit and an exemption?
A permit requires the sponsor to justify that the project is needed and financially and economically feasible. Exemptions are not based on need, according to the Board's program page.
Does buying or closing a facility need Board approval first?
Change of ownership, discontinuation of a category of service and closure are exemption projects on the Board's page. Long-term care facilities need no permit or exemption to close or change ownership but must report it. State-maintained facilities must seek a permit before closing and cannot get an exemption. Where an exemption applies to an acquisition, rule 1130.520(a) requires the application, the fee and approval before the person acquires, or contracts to acquire, the facility.
Must a sponsor file a letter of intent before applying?
No. Section 6(a) says the Board shall not require an applicant to file a Letter of Intent before an application is filed.
Who signs and verifies the application?
Section 6(c) says all applications are signed by the applicant and verified by any two officers of the applicant, so the sponsor needs two officers available at filing.
How long does Board review take?
Staff decide completeness within 10 business days, then review runs at least 30 days and not more than 60 days for non-substantive or 120 days for substantive projects, with shorter periods for some (rule 1130.610(b)).
What happens if the Board denies a permit?
A failed first vote is an Intent to Deny; the applicant has 14 calendar days to say in writing whether it will appear or submit information, and an application is considered withdrawn if the applicant waives appearance or does not respond in 14 days. Under the text now in force, a written hearing request after a denial must be served on the Chairman within 30 days following notification.
What does IHS draft, and does IHS deal with the Board?
IHS drafts the narrative, worksheets, exemption packet and review calendar. IHS does not file with, call or correspond with the Board. The sponsor files and attends.