Iowa is one of 35 certificate of need states that require healthcare providers to apply for this specific type of permit before building or expanding operations. The application and regulatory framework of the Iowa certificate of need (CON) differs from other states, but its intent is the same. It's meant to ensure that Iowa residents have access to adequate care without bearing the costs of an overinflated, duplicative healthcare infrastructure.
If you're looking to extend your facility's available trauma care level in Des Moines, you'll need to obtain CON approval first. Here's an overview of the process to help expedite planning.
Certificate of Need: Iowa Rules and Regulations at a Glance
Fulfilling certificate of need requirements in Iowa can take as long as 150 days. To help you navigate this lengthy process, we've compiled a list of the must-knows. Having this information at the start of your project's planning stage can help you build efficiencies, preserving valuable time and resources for what you do best — delivering high quality patient care.
| Iowa Certificate of Need Summary | |
|---|---|
| Legal Authorities | Iowa Code, Title I, Chapter 10A:Section 10A.711 to Section 10A.729Iowa Administrative Code, Inspections and Appeals Department (481):Chapter 2202,Rules 481.2202.1 to 481.2202.16Chapter 2203,Rules 2203.1 to 481.2203.13 |
| Requirements | Facilities that are regulated by Iowa CON laws can include:HospitalsHealthcare facilities (skilled nursing facilities, for example)Organized outpatient health facilities (such as astand-alone urgent care)Ambulatory surgical centersMobile health services (like a mobile dentist)There are also many healthcare activities that require a certificate of need. Examples include (but aren’t limited to):Constructing, establishing, or expanding any healthcare facility regardless of ownership.Any capital expenditure exceeding $1.5 million within a 12-month period.Removing or relocating existing services.Permanently changing bed capacity.Acquiring major medical equipment.Implementing specialty services such as cardiac catheterization, open heart surgeries, or organ transplantations.Facilities and services that areexempt from the CONprocess can include certain:Private practices and private clinics.Dispensaries and first aid stations (like a school nursing office).Hospitality organizations that provide health-related services incidental to their primary business.Religious care facilities that provide exclusively spiritual healing.Infrastructure unrelated tocare provision(such as expanding a parking lot).Hemodialysis and hospice services provided by a hospital.Reducing bed availability or medical services under certain conditions.If a project appears to fall outside of CON-review requirements, arequest for nonreviewabilitymay be made. If a CON is still necessary, the request will then be considered a letter of intent (required 30 days before the formal application). |
| State Agency | TheIowa Department of Health and Human Services(HHS) oversees the Iowa Certificate of Need Program. Use the followingcontact informationto connect with a state representative about the program:Phone: (888) 278-6017Email: CertificateOfNeed@hhs.iowa.gov |
| Fees | Application fees are determined by the cost of the proposed venture.The fee is 0.3% of the total expenditure with a minimum fee of $600 and maximum fee of $21,000.If an application is voluntarily withdrawn, reimbursement is based upon the amount of notice given.Within 30 calendar days of the application’s submission:75%of the fee is refunded.Between 30-60 days of the application’s submission:50%of the fee is refunded.Greater than 60 days from submission:25%of the fee is refunded. |
| Application Forms | No fewer than 30 days before applying for a CON (but ideally as soon as possible within the planning process), applicants must submit aletter of intent (LOI)to the Iowa HHS. The LOI must include:A concise description of the proposed project.The location of the intended services.The estimated cost.Iowa certificate of need applications (alongside all pertinent attachments) must be delivered by email to the Iowa HSS using the appropriate form.Iowa CON Application FormOther pertinent forms include:CON Progress Report FormCON Extension Request FormCON Reduction of Bed Capacity FormCON Deletion of Health Service FormCON Closure of Institutional Health Facility FormCON Redistribution of Licensed Acute Beds Form |
| Penalties | Failure to comply with CON regulations can result in denied or revoked licensure. Penalty fees are leviedaccording to violation type.AClass I Violationoccurs when a healthcare entity offers a new or changed service without prior CON approval.The penalty fee is$300 per dayuntil the issue is resolved.AClass II Violationoccurs when the terms of a prior-approved CON are violated.The penalty fee is$500 per dayuntil the issue is resolved.Facilities can also face a civil penalty for failure to file required reporting documents, with a fee of up to$500 per offense. |
The Illinois Certificate of Need Application Steps
The process for obtaining an Iowa CON begins with the submission of a letter of intent and ends with a final decision by HHS. Here's a look at all of the steps in the process.
1. Letter of Intent Provision
At least 30 days before submitting an application, the applicant submits an LOI. The department may respond to this letter cautioning the potential reasons for an application's denial, or with guidance on how to proceed.
2. Application Submission
The applicant will submit the completed application form with all required and relevant attachments and also submit the required fee.
3. Application Review
Within two weeks of receipt, the department will review the application's completeness, request additional information if required, and notify affected parties (as needed).
4. Application Evaluation
At this stage, the Iowa HHS begins the evaluation process. Supporting documentation must adhere to the criteria for evaluation.
5. Evaluation Report
A departmental evaluation report is drafted after the evaluation period. This will acknowledge the review of the evaluation criteria, letters of opposition and support, and relevant public hearing information.
6. Internal Meetings
Here, the expertise of the HHS health economist alongside Medicaid, Aging and Disability Services, and behavioral health subject matter experts is utilized for a final review of the report. Their input will help guide the final decision.
7. Final Decision
After the HHS has made a final decision to approve or reject an application, the applicant will be notified via letter.
Controversy Around the Certificate of Need: Iowans' Concerns and Pushback
The question, What is a certificate of need in healthcare's true purpose? has prompted many Iowans to fight for the repeal of CON laws. Some argue that although the original purpose of the law may have been well-intended, its intent was never realized. Those complaints are reflected by reviews that indicate abolishing CON requirements could save Iowans significant healthcare costs while improving access to acute care services in rural areas currently struggling to meet patient demand.
Simplify Your Regulatory Compliance Challenges
Changes to regulations — like those that updated the Iowa certificate of need — can make compliance an ongoing (and tedious) process. Credenza is here to help. With our expert-backed facility guides, the latest regulatory standards become easy to understand and maintain.
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.