Certificate of Need (CON) legislation encompasses federal/state authorizations to acquire, expand, or create facilities and is used to regulate supply of services relative to demand by eliminating overspending or limiting (pro- tecting) access. As of 2017, 36 states retain some type of certificate of need (CON) program, law, or agency. CON programs originated to regulate the number of beds in hospitals and nursing homes and to prevent overbuying of expen- sive equipment. In 1964, New York became the first state to enact a statute granting the state government power to determine whether there was a need for a new hospital or nursing home before it was approved for construction. In 1972, an amendment to the Public Health Service Act included withholding of Medicare and Medicaid funds for facilities and projects – which in effect became the first CON legislation, although a version was incorporated into the Hill-Burton Act (1946) that provided federal funds for new hospital construction completed through state planning and evaluation. The National Health Planning and Resources Development Act in 1974 strengthened CON regulations by requir- ing all 50 states to implement such regulations to receive funds through the federal govern- ment; however, sanctions from this law were not imposed.
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