Last updated: November 2026. Statute, regulation and Cabinet pages opened 2026-11-05.
Kentucky's certificate of need process authorizes actions covered by KRS Chapter 216B, subject to its exceptions. For providers' planning, finance and legal leaders, Integral Healthcare Solutions (IHS) drafts application narratives, worksheets, ownership schedules and review calendars. The applicant files and attends.
What does Kentucky require for a certificate of need?
Unless the chapter provides otherwise, Kentucky bars a person from eight listed actions without first obtaining a certificate of need. The governing text is KRS Chapter 216B on the Legislative Research Commission site: 216B.061 (effective July 15, 2026), 216B.062, 216B.040, 216B.020, 216B.015 and 216B.085 (pages opened 2026-11-05).
- The eight actions (216B.061(1)): establish a health facility; obligate a capital expenditure above the minimum; substantially change bed capacity, a health service or a project; acquire major medical equipment; increase a geographical area or alter a location designated on a certificate or license; transfer an approved certificate for establishing a new health facility or replacing a licensed facility.
- A project cannot be split to evade an expenditure minimum; acquiring functionally related diagnostic or therapeutic equipment counts as one project (216B.061(2)).
- No ex parte contact with the final decision-making authority about an application from the commencement of the review cycle to the final decision; any contact that occurs is promptly made part of the record (216B.061(3)).
- A certificate is issued for a specific location and, when applicable, a designated geographical area (216B.061(6)).
- An ambulatory surgical center needs a certificate and a license notwithstanding any exemption in 216B.020; one licensed as of July 12, 2012 need not obtain a certificate to continue operating (216B.061(7), (8)).
What is the capital expenditure minimum, and what counts toward it?
The minimum is an annually adjusted amount set by the Cabinet, and the cost of studies, surveys, designs, plans, working drawings, specifications and other essential activities counts toward it (216B.015(8)). The major medical equipment minimum counts studies and plans the same way (216B.015(17)).
The Cabinet's certificate of need page reports both minimums as 4,227,622 dollars effective January 1, 2026. KRS 216B.130 requires annual adjustment; 900 KAR 6:030, Section 3 specifies July 1 adjustment and publication. These source dates differ; counsel should verify the applicable threshold before a capital obligation or equipment acquisition. Pages opened 2026-11-05.
Who needs a Kentucky certificate of need, and what triggers it?
A provider needs one when its project is one of the eight actions and no exemption applies. KRS 216B.020(1) lists facilities and services to which the certificate provisions do not apply, including: end stage renal disease dialysis facilities, freestanding or hospital based; outpatient behavioral health treatment, but not including partial hospitalization programs; and freestanding birthing centers as defined in KRS 216B.198. They remain subject to licensure when applicable. Whether an exemption fits is a question for counsel.
How does the Kentucky certificate of need review work?
Applications follow timetables the Cabinet sets by regulation. Once it deems an application complete, the Cabinet gives notice of the review's beginning, the proposed schedule and the right to request a hearing. Review commences on the date of notice, and no review takes longer than 90 days from commencement unless the applicant agrees to a deferral of action (216B.062(1)).
- Batching. Applications for the same or similar services, facilities or equipment are batched, excluding those granted nonsubstantive review status; the Cabinet reviews and, if appropriate, compares timely-filed applications for similar services in the same health service areas (216B.062(2)).
- Formal-review hearings. Affected persons have 15 days after review begins to request a hearing. Parties may have counsel and reasonably cross-examine under oath persons making relevant factual allegations (216B.085(1), (3)).
- Formal-review issuance. The decision rests solely on the record. An approved certificate is issued 40 days after decision notice unless reconsideration is requested or issuance is enjoined on judicial appeal (216B.085(4)).
- Nonsubstantive review. An applicant may request this track under KRS 216B.095 (effective July 14, 2022; page opened 2026-11-05), waiving formal-review procedures. If status is denied, formal review follows. If granted, other affected persons have 10 days after notice to request a hearing; the decision is due within 35 days of the status determination. An approved certificate is issued 30 days after decision notice unless issuance is enjoined on judicial appeal.
What must a Kentucky certificate of need application show?
The statute limits the Cabinet's issuance and denial criteria to a list of considerations (216B.040(2)(a)2).
The six categories are plan consistency; need and accessibility; interrelationships and linkages; costs, feasibility and resources; quality; and hospital-based long-term care beds. These are headings, not the complete tests: KRS 216B.040(2)(a)2 (effective July 14, 2018; page opened 2026-11-05) supplies the qualifications counsel must address, including biennial budget limits, demographic service-area analysis, coordinated care and ongoing staffing and financing. It also addresses conditional preference for bed conversions, excludes specified continuing-care retirement community beds from long-term-care need calculations, and bars disapproval merely because the plan does not address the proposal type.
The application includes the name and business address of each owner, investor or stockholder whose ownership interest in the project exceeds ten percent (216B.062(1)).
How does IHS prepare a Kentucky certificate of need application?
IHS works as an outside drafting team under your planning and finance leaders and your counsel, in five steps.
- Gap assessment. IHS compares your project plan to KRS 216B.061 and 216B.062 and lists what is missing.
- Evidence mapping. IHS maps each 216B.040(2)(a)2 consideration to its evidence.
- Drafting. IHS drafts the narrative, worksheets, ownership schedule, review timeline and attachment checklist for your leaders and counsel to approve.
- Mock review. IHS reads the draft as a reviewer would.
- Readiness support. IHS drafts a post-approval project tracker that flags any substantial change.
What you supply: the project description, cost, location and service line; need, utilization and financial data; counsel for reviewability, hearings and appeals; and the filing, fee and attendance.
The real limit: the applicant files and attends. IHS never contacts the Cabinet for you, gives no legal advice on whether a project needs a certificate, on exemptions or on appeals, and does not guarantee approval.
IHS was founded in 2002 and is led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC. Its three practice lines are accreditation consulting, compliance services and program development; this program sits in compliance services.
What should an applicant have ready for a Kentucky certificate of need?
- Counsel's reviewability assessment under KRS 216B.061 (2026) and KRS 216B.020 (2025).
- Threshold verification and costs including studies and plans: KRS 216B.015(8), (17) (2025).
- Project description, location and aggregation of functionally related diagnostic or therapeutic equipment: KRS 216B.061(2), (6) (2026).
- Names and business addresses for ownership interests above ten percent: KRS 216B.062(1) (1996).
- Evidence for the review considerations: KRS 216B.040(2)(a)2 (2018).
- A calendar for the applicable review track: KRS 216B.062 (1996), KRS 216B.085 (2025), and KRS 216B.095 (2022).
- Fee submitted with the application: 900 KAR 6:020 (certified 2025).
- A protocol preventing prohibited ex parte contact, including by counsel: KRS 216B.061(3) (2026).
Source years identify the linked versions; pages opened 2026-11-05.
If most of these do not exist yet, a free introductory call with IHS sorts what to build first.
How does an outside application build compare with the other routes?
| Route | What it involves | Where the work sits |
|---|---|---|
| Internal build | Planning and finance staff write the narrative and worksheets. | Your staff time. |
| Counsel | Advises on reviewability, exemptions, hearings and appeals. | Legal determinations, which IHS does not give. |
| Outside drafting support (IHS) | IHS drafts the narrative, worksheets and calendar. | IHS drafts; the applicant files and attends. |
What does a Kentucky certificate of need application cost?
The Cabinet sets its fee by regulation under KRS 216B.040(3)(c). 900 KAR 6:020 (opened 2026-11-05) assesses:
- No capital expenditure, or up to 200,000 dollars: 1,000 dollars.
- Greater than 200,000 dollars up to 5,000,000 dollars: five-tenths of one percent of the capital expenditure, computed to the nearest dollar.
- Greater than 5,000,000 dollars: 25,000 dollars.
- An existing licensed facility or service that met the emergency circumstances provision in 900 KAR 6:080 and received the Office of Inspector General's notice that an emergency exists: 100 dollars.
The fee is submitted with the application, the application is not deemed complete until it is paid, and it is refunded only if the Cabinet receives notice of withdrawal within five working days of receiving the application. Verify current fees with the Kentucky Cabinet for Health and Family Services. 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. Whether a project needs a certificate, whether an exemption applies and any hearing or appeal are questions for your counsel. It is not a filing service, and it is not a guarantee of approval. The applicant files and attends, and IHS has no contact with the decision maker.
Frequently asked questions
What is a certificate of need in Kentucky and which projects need one?
It is the Cabinet for Health and Family Services' authorization under KRS Chapter 216B. Unless the chapter provides otherwise, a person needs one before any of the eight actions in KRS 216B.061(1), such as establishing a health facility or acquiring major medical equipment.
Does my project need a certificate in Kentucky?
KRS 216B.061(1) requires prior authorization for listed actions unless Chapter 216B provides otherwise. Counsel should assess applicable exceptions throughout the chapter, not only 216B.020(1).
What must a Kentucky certificate of need applicant show?
The application identifies each owner, investor or stockholder whose project ownership exceeds ten percent, including name and business address (216B.062(1)). Its evidence addresses the qualified review considerations in 216B.040(2)(a)2, summarized above.
How long does Kentucky certificate of need review take?
Under 216B.062(1), review begins with notice after completeness and lasts no more than 90 days unless the applicant agrees to defer action. Nonsubstantive review has a 35-day decision deadline from its status determination (216B.095(1)); preparation and issuance are separate.
Can the applicant talk to the decision maker during review?
KRS 216B.061(3) prohibits anyone's ex parte contact about the application with the final decision-making authority from review-cycle commencement through final decision. Any such contact must promptly enter the record; that reporting duty does not authorize the contact. IHS never contacts the Cabinet for you.
Can approved projects be changed or moved?
Unless Chapter 216B provides otherwise, 216B.061(1)(e), (g), (h) require a certificate for substantial project changes, changes to designated locations or increases to designated areas, and transfers of certificates for new facilities or replacements of licensed facilities. Under 216B.061(4), a person must receive the Cabinet's administrative escalation as prescribed by regulation before obligating capital above the amount authorized by an existing certificate; subsection (5) bars further capital obligations under an approved certificate after a substantial project change.
What is the Kentucky certificate of need application fee?
Under 900 KAR 6:020, ordinary fees range from 1,000 to 25,000 dollars by capital expenditure. The 100-dollar fee applies to an existing licensed facility or service meeting 900 KAR 6:080 emergency circumstances and receiving OIG notice of an emergency. Verify current fees with the Kentucky Cabinet for Health and Family Services.
What happens if a project starts without a certificate?
KRS 216B.990(2) covers a willful violation of the chapter by acquiring major medical equipment, establishing a health facility or obligating a capital expenditure without first obtaining a certificate, or after the applicable certificate has been withdrawn. The fine is one percent of the capital expenditure, with a minimum of 500 dollars per violation.
Related pages
See the Compliance Services overview | State licensing and certificate of need | CON application state tracker.