Last updated: November 2026
A Tennessee certificate of need (CON) is the Tennessee Health Facilities Commission's approval of a proposed health care project, and the process runs on a fixed monthly calendar that begins with a letter of intent (LOI). Integral Healthcare Solutions (IHS) prepares applicants for that calendar: we build the timeline, draft the application narrative and worksheets, and prepare the team for the hearing. The applicant files and presents.
This page follows the Commission's own pages and rules step by step. It is not legal advice, and IHS is a consulting firm, not a law firm.
What is a Tennessee certificate of need?
It is the Commission's approval of a proposed health care project, granted through a process that begins with a letter of intent. The governing text for this page is the Commission's CON process and how to apply page and CoN Basics page, and the Commission's rules, Chapter 0720-10 (Certificate of Need Program - Scope and Procedures) and Chapter 0720-11 (Certificate of Need Program - General Criteria), in the versions marked July 2022 (Revised). All were opened 2026-11-05.
The sequence, from the process page and Rule 0720-10-.02:
- The application is commenced by filing the Letter of Intent (LOI) electronically through the e-application portal between the 1st and the 15th of any month.
- The LOI must be published in a newspaper of general circulation in the county where the project will be located, during that same 15-day period. Under Rule 0720-10-.02(2)(d)1., filing and publication must both fall in that window, which applies to the month before the application is filed. Applications seeking simultaneous review use the 16th through the last day of the month, and a filing deadline on a weekend or State holiday moves to the next regular business day. Missing the window voids the LOI.
- For an application for or by a home care organization, publication is required in each county in which the agency will be licensed, or in a regional newspaper that qualifies in each county. With more than one newspaper, the earliest publication date is used for competition deadlines and for filing the application.
- The CON application and filing fee are due by the first day of the following month, through the e-application portal. Under the rule, failing to file by the first day of the month after publication (the next regular business day if that day is a weekend or State holiday) voids the LOI and the application.
- Staff check completeness and may request supplemental information; under the rule, responses are due within 60 days of the first written request, or the application is considered withdrawn. Entry into the next review cycle depends on being deemed complete; the process page lists close of business on the fourteenth as the cutoff and the fifteenth as the cycle start, as specified in Commission Rules.
- The review cycle is typically 30 days. Materials go to the 15-member board about 12 days before the meeting.
- At the meeting the applicant makes a 10-minute presentation, supporters and opponents may testify, members may question the parties, and the Commission votes to approve or deny. In certain circumstances an application may be deferred so additional information can be obtained.
- Approval or denial letters issue within a week of the decision; for an approved project, the certificate issues within 4 weeks of the decision.
- Decisions may be appealed up to 15 days under certain conditions noted in T.C.A. section 68-11-1609(g)(1) and (2).
Rule 0720-11-.01 sets out the general criteria the Commission considers, including need, quality, and whether the effects of competition or duplication would be positive for consumers.
Who needs it and what triggers it
Tennessee CON applicability depends on the project, service, location and exemptions. The Commission's CoN Basics page lists covered institution and service categories, exclusions, and qualified triggers for bed changes, relocations and imaging services. Read it with the Certificate of Need Exemptions page, including its geographic exemptions and notification procedures (both pages opened 2026-11-05). Have counsel assess applicability before planning a CON filing.
The Commission's process page also carries an alert for new home health and hospice applicants about a nationwide Medicare enrollment moratorium, and the alert gives May 20, 2026. CMS memorandum QSO-26-11, dated May 20, 2026, says it is effective May 13, 2026 (CMS memorandum and CMS provider enrollment moratoria page, both opened 2026-11-05). It addresses new hospice and HHA Medicare enrollments, including new HHA branch or practice locations, and says:
- The moratorium is in place for six months and can be extended for additional six-month periods, if necessary. Six months from May 13, 2026 reaches mid-November 2026 (IHS's arithmetic), so confirm current status with CMS; an extension or lift will be announced in the Federal Register.
- Prospective hospice or HHA Medicare enrollment applications received by the applicable Medicare contractor before May 13, 2026 continue to be processed; affected initial applications submitted during the moratorium are denied and must be resubmitted after it is lifted.
- For prospective hospice or HHA providers, accreditation by a CMS-approved accrediting organization does not establish Medicare participation through deemed status during the moratorium.
A home health or hospice applicant should plan the CON calendar and Medicare enrollment timing together; our home health and hospice page covers the federal side.
How IHS helps
- Gap assessment. We compare the project and its data with the process page, Rule 0720-10-.02 and the Rule 0720-11-.01 criteria.
- Evidence map. We list the data and documents the narrative needs and who produces each.
- Drafting. We draft the narrative, need and utilization worksheets and timeline, with clinical and financial content for the applicant's team to review, change and approve.
- Mock hearing. We draft the 10-minute presentation and likely questions with drafted answers, for the applicant's team to rehearse.
- Readiness support. We keep the calendar and open items current until the applicant is ready to file.
The client supplies the project description, financial and utilization data, governing body approvals and the presenters. IHS is principal-led by Thomas G. Goddard, JD, PhD, founder of Integral Healthcare Solutions and former Chief Operating Officer and General Counsel of URAC. CON work sits in program development and compliance services.
The real limit: the Commission decides. IHS does not file, contact or act as liaison to the Commission, and it does not give legal conclusions. The applicant files, publishes and presents.
What to have ready
Use these Commission resources, opened 2026-11-05, alongside the governing text identified above.
- An LOI, portal access and a publication plan addressing the filing window and applicable county coverage: CoN Process, step 1.
- The application and filing fee ready for the deadline: CoN Process, step 2. Verify current fees with the Commission.
- If requesting Department of Health data, a request planned 45 days before the LOI: Criteria and Standards.
- A narrative and service-specific evidence mapped to Criteria and Standards, with the relevant worksheets from CoN Application - Apply Here.
- A team ready to present and answer questions: CoN Process, steps 8 to 10.
- A follow-up plan, with counsel assessing appeal conditions: CoN Process, steps 12 and 13.
Use a free introductory call to discuss the checklist and scope the work.
How it compares
A CON is an approval of a proposed project, placed prior to licensure by the Commission's CoN Basics page.
| Item | What it is | Where to read more |
|---|---|---|
| Tennessee CON | Commission approval through a monthly process with a hearing. | This page and the Commission links above. |
| Other states' CON programs | Check the relevant state authority's current requirements before using a Tennessee filing timeline for a project elsewhere. | The CON state tracker, CON application and State licensing and CON overview pages. |
What it costs
A Tennessee CON has three cost parts: authority fees, consulting fees and internal time.
Authority fees. Rule 0720-10-.02(5) sets the initial examination fee at 2.25 dollars per 1,000 dollars of estimated capital expenditure, with a minimum of 3,000 dollars and a maximum of 45,000 dollars, and the rule calls the filing fee non-refundable. The July 2022 rule text is the version opened; verify current fees with the Commission. LOI publication is a separate cost, and Department of Health data may carry fees.
Consulting fees. IHS scopes each engagement after a free introductory call and states no consulting fee on this page. The scope moves with project type, data work and county count. Your own leadership, finance and clinical staff time is the third cost.
What this is not
- It is not legal advice. IHS is a consulting firm, not a law firm.
- It is neither a guarantee of Commission approval nor a facility license.
- It is not a filing service. IHS does not submit to or deal with the Commission for the applicant.
Frequently asked questions
Does my project need a Tennessee certificate of need?
It depends on the project, location and applicable exemptions. The Commission's CoN Basics and Certificate of Need Exemptions pages describe covered activities and exceptions (pages opened 2026-11-05). Have counsel assess applicability before planning a filing.
When can I file the letter of intent?
File the LOI electronically through the e-application portal between the 1st and 15th of a month. Publish it in the same window. Under Rule 0720-10-.02(2)(d)1., missing the window voids the LOI. Applications seeking simultaneous review use the 16th through the last day of the month, and if the last day for filing falls on a weekend or State holiday, filing may occur by the next regular business day. The process page lists the window (opened 2026-11-05).
What must be published in the newspaper?
Publish the LOI information in a newspaper of general circulation in the project county during the same 15-day filing window. For an application for or by a home care organization, publish in each county where the agency will be licensed, or in a regional newspaper qualifying as a newspaper of general circulation in each county. When more than one newspaper is used, the earliest publication date governs competition deadlines and application filing.
When is the application due?
The CON application and filing fee are due by the first day of the following month, through the e-application portal. Under Rule 0720-10-.02(4), failing to file by the first day of the month after publication (the next regular business day if it falls on a weekend or State holiday) voids the LOI and the application.
How long is the review?
The Commission describes a typical 30-day review cycle, starting on the fifteenth as specified in Commission Rules, after staff deem the application complete. This is not the total time from preparation to approval. Decision letters issue within a week; for approved projects, certificates issue within 4 weeks of the decision.
What happens at the Commission hearing?
The applicant makes a 10-minute presentation on how the application meets the criteria. Supporters and opponents may testify, members may question them and discuss the application in public, and the Commission votes to approve or deny; in certain circumstances an application may be deferred so additional information can be obtained. IHS drafts the presentation and likely questions for rehearsal.
What does it cost?
Budget for the Commission's filing fee and your team's preparation time. Rule 0720-10-.02(5) sets the initial examination fee at 2.25 dollars per 1,000 dollars of estimated capital expenditure, with a minimum of 3,000 dollars and a maximum of 45,000 dollars; verify current fees with the Commission. IHS scopes consulting work after a free introductory call.
Can a decision be appealed?
Commission decisions may be appealed up to 15 days under certain conditions, according to the process page, which cites T.C.A. section 68-11-1609(g)(1) and (2) and, for the appeal process, section 68-11-1610. Ask counsel about the conditions.
Is a CON the same as a license?
No. The CoN Basics page places CON approval before establishment, licensure or certification for covered institutions. IHS reads that wording as distinguishing CON approval from the license itself (reading dated 2026-11-05). This page covers CON preparation only.