1. Determine Which Hospital Projects Need Con Review
Before budgeting a hospital project, identify exactly what will change. Public Health Law § 2802 generally requires prior approval for hospital construction, subject to statutory exceptions. Under 10 NYCRR § 710.1, the review route depends on the facility, proposed services, bed changes, and total project cost. A minor-looking renovation can still affect licensed services.
Identify Changes That Trigger an Application
A new hospital building requires an application. Changes to certified bed capacity or licensed services can also trigger review regardless of cost.
- Identify new buildings, acquisitions, additions, and changes in licensed clinical services.
- Compare existing certified beds with the proposed bed count and level of care.
- Calculate total project cost, including equipment, design fees, and related expenses.
Separate Con Applications from Notice-Only Work
Some work needs advance notice instead of a CON application. Qualifying repairs or specified nonclinical work costing up to $12 million may need no notice.
- Separate ordinary maintenance and equipment replacement from clinical renovations.
- Check project cost, clinical impact, and whether related work must be combined.
- Supply advance notice, licensed-professional certifications, and patient-safety plans when required.
2. Choose the Review Route before Fixing the Budget
Not every CON filing receives the same review. The August 2025 amendments to 10 NYCRR § 710.1 revised cost thresholds. Bed changes, specialized services, and exceptions may change the filing route even when the budget stays fixed. Classify the project before setting a construction date.
Compare Review Routes and Triggers
Project cost matters, but a service or bed change can move an application into a different category.
| Route | Typical Consideration |
|---|---|
| Full review | Costs above the applicable cap, bed additions over 10%, or specified services |
| Administrative review | Eligible mid-cost projects and specified bed or service changes |
| Limited review | Eligible lower-cost projects and designated service or bed changes |
| Notice or no notice | Qualifying maintenance and nonclinical work, subject to conditions |
Test Cost and Clinical Exceptions Together
General-hospital construction over $30 million generally needs a CON application. Full review depends on cost and clinical triggers.
- Compare $60 million with the operating-cost-based threshold and its cap.
- Flag bed additions above 10%, higher-care conversions, and specified cardiac or transplant services.
- Review the project under healthcare regulations before selecting a filing track.
3. Prepare Evidence That Supports the Con Application
A floor plan alone will not explain why a hospital needs more space or beds. Applications may require evidence of public need, financing, operations, and facility design. Inconsistent budgets and drawings can delay review. Match the NYSE-CON schedules to the proposed services.
Connect the Service Plan to the Facility Design
A hospital expansion should describe which patients it will serve and how the physical space supports that care.
- Explain proposed services, anticipated capacity, and the need for the project.
- Coordinate architectural drawings with equipment and licensed-service plans.
- Assess whether a design and architectural law review is warranted.
Check Financial and Filing Materials
The cost estimate should include more than the contractor's construction price. Supporting schedules must match the chosen review route.
- Reconcile real estate, equipment, consultant fees, and financing costs.
- Prepare financial schedules, design submissions, and environmental review materials as applicable.
- Verify the applicant's establishment or ownership approvals where applicable.
4. Keep Construction Approval Separate from Opening
A favorable CON decision alone does not authorize construction or patient care. Clear preconstruction contingencies before proceeding. If the project requires a pre-opening survey, the regional office must approve opening. Changes to licensed operations may require a revised operating certificate.
Confirm Conditions before Starting Work
Approval letters may require final drawings or other documents before work begins. Build these conditions into the schedule.
- Check the approved scope, site, and unresolved preconstruction conditions.
- Submit required final drawings, certifications, and safety documents.
- Seek review of material changes rather than assuming the approval covers them.
Verify Readiness before Patient Services Begin
When a pre-opening survey applies, resolve findings before the agency authorizes opening. Certificate changes follow the approved scope.
- Arrange any required regional-office survey and submit the necessary documents.
- Correct survey findings and verify the approved services and bed capacity.
- Review hospital licensing and permits before opening.
5. Frequently Asked Questions
Does an existing hospital need CON approval to replace old equipment?
Not always. One-for-one replacement may qualify for advance notice, while eligible routine work may require no notice.
Can a hospital start construction after a conditional CON approval?
Not necessarily. The hospital must first satisfy any preconstruction contingencies and obtain the required authorization to proceed.
Does CON approval replace local building permits?
No. State healthcare approval does not automatically eliminate applicable local construction, zoning, or building-code obligations.
Can a hospital change its proposed site after CON approval?
Possibly, but the approved project scope and site matter. Ask the Department whether an amendment or additional review is required.
6. Review Your Hospital Con Plan with Sjkp
A filing route that does not match the construction plans can delay a hospital project. SJKP’s attorneys can review CON classifications, application materials, and outstanding approval conditions. Contact SJKP to discuss the requirements before construction or opening.
20 May, 2026
