Certificate of need (CON) laws require approval for major changes within a state's healthcare industry, with regulations that vary by state. In Hawaii, certificate of need laws apply to many areas of healthcare, including inpatient medical care, inpatient behavioral care, and long-term care. Investors and providers that plan to make significant changes within these categories may be asked to show that their project is needed by the community.
Hawaii faces unique challenges in terms of public health, including an aging population and rising rates of type 2 diabetes. CON regulations aim to help residents meet health challenges by controlling healthcare costs, aligning new offerings with the state's overarching public health objectives, and preventing unnecessary duplication of services. In this guide, we'll go over Hawaii's CON program in more detail.
Certificate of Need: Hawaii's Laws at a Glance
Hawaii's CON laws, established in 1975, are often up for debate due to ongoing concerns about residents' access to care. For example, the proposed 2024 Senate Bill 2123 would have exempted psychiatric and dialysis services from CON requirements. Hawaii's public health policies change to account for the state's changing demographics and evolving service needs of residents.
The following chart highlights up-to-date information about key laws, criteria for need, and steps in the application process. We'll also provide you with links to helpful resources, so that you can ensure you're following the current requirements.
| Hawaii Certificate of Need Summary | |
|---|---|
| Legal Authorities | Hawaii Revised Statutes, Volume 6, Chapter 323D:Sections 323D-42 to 323D-54Hawaii Administrative Rules (HAR), Title 11:Sections 11-186-1 to 11-186-125 |
| Covered Entities, Services, or Actions | The process is administered by the State Health Planning and Development Agency (SHPDA), within the Hawaii Department of Health. Certificate of need regulations cover many facility types and activities.The facilities regulated by CON laws can include (but aren’t limited to):Medical inpatient facilitiesMedical outpatient facilitiesBehavioral inpatient facilitiesMedical imaging facilitiesLong-term care facilitiesA CON is required before a healthcare entity or providerperforms certain actionswhich can include:Construction, modification, or alteration of a healthcare facility (in excess of certain minimum expenditures as defined inSection 323D-2)Substantial modification or increase of offered servicesChanges to class of usage of the bed complement of a healthcare facilityRelocation of beds from one site to anotherSome providers and facility types areexempt from the CON requirements, such as:Private practice offices (with exceptions).Laboratories (with exceptions).First aid stations in businesses that serve employees.Infirmaries or dispensaries in correctional or educational facilities. |
| Establishment of Need | Applications are evaluated to determine if there is a need for the new/expanded facility or service. Need is established based on the following6 categories of criteria:Level of alignment with theState Services and Facilities PlanNeed for the change andaccessibility of the healthcarethat would be offeredQuality of the service or carebeing providedCost and financial impactRelationship to the healthcare system and the existing alternativesAvailability of resources (i.e., staffing and funds) |
| Duration of Process | Once a Hawaii certificate of need application is deemed complete, thestandard review processtypically occurs within 90 days. Certain proposals may qualify for a morestreamlined administrative reviewprocess. |
| Enforcement Agency | Enforcement of CON regulations occurs through theState Health Planning & Development Agency, within the Hawaii Department of Health.Certificate of need regulations may also apply once a healthcare project is approved. In some cases, SHPDA monitors implementation of the project, and requires periodic reports. |
| Fees | Thefee for a Hawaii certificate of need applicationincludes a base fee of $200, plus 0.1% of the cost of the project up to $1,000,000.For projects above that limit, an additional 0.05% of the project’s cost that is in excess of $1,000,000 will be added on. |
| Application Forms | Individuals planning to file a CON application may file a letter of intent (LOI) with SHPDA as explained in Section 11-186-20. Applicants will then submit astandard or administrative application form, along with the correct fee.Toqualify for an administrative review, applicants would meet one more more criteria, including:Changes with a capital or annual operating expense below certain amounts.Changes that will not create a significant impact on the existing healthcare system. |
| Penalties | Entities or providers that fail to comply with the Hawaii certificate of need regulations mayface sanctionsthat include:Misdemeanor chargesRevocation or suspension of related licensesMonetary penalties |
Regulating Healthcare With a Certificate of Need: Hawaii's History
Hawaii developed its CON program in 1975, in response to the National Health Planning and Resources Development Act of 1974 (NHPRDA), which linked federal funding to state-run CON programs. By 1980, most U.S. states regulated healthcare with a CON program. When the NHPRDA's certificate of need mandate was repealed in 1987, some states discontinued their programs and others scaled back. In Hawaii, the restrictions remained robust.
Resources for Pursuing a Hawaii Certificate of Need
If you plan to apply for a CON, you have many options for demonstrating that your healthcare service is needed from a community health perspective. As you gather evidence, you may want to take advantage of the resources and publications offered by SHPDA. Hawaii's healthcare utilization statistics are collected and shared yearly. Additional sources for public health data include:
- Hawaii Integrated Behavioral Information System (HI-IBIS)
- Hawaii Health Data Warehouse
- University of Hawaii System: Hawaii Health Statistics
Get More Insights to Help Your Facility's Growth
If your goals involve providing healthcare to more members of your community, you'll need to understand the Hawaii certificate of need process. We're here to support your facility's expansion and ongoing success with our expert-written healthcare insights and resources.
Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.