Certificate of Need Laws in Maryland — What Patients Need to Know
Maryland has one of the most heavily regulated healthcare markets in the United States, combining a Certificate of Need (CON) law with a unique global hospital budget system. Enacted in 1978 and last amended in 2023, the state’s CON program requires healthcare providers to obtain approval from the Maryland Health Care Commission before establishing or expanding certain medical facilities and services. Understanding how these regulations work is important for Maryland patients navigating healthcare options and costs.
MARYLAND — KEY FACTS
| CON Law Status | ACTIVE CON LAW |
| Programme Scope | active |
| Year Enacted | See agency |
| Services Requiring Approval | hospitals, nursing homes, ambulatory surgery centres, imaging equipment (MRI/CT), dialysis facilities, hospice providers, psychiatric facilities, home health agencies |
| Governing Agency | Maryland Health Care Commission |
| Hospitals in State (CMS data) | Data not available |
The Arguments
WHAT SUPPORTERS ARGUE
Defenders of Maryland’s CON laws argue that the regulatory framework, particularly when paired with the state’s global hospital budget system, helps control healthcare costs and prevent unnecessary duplication of expensive medical services. Proponents contend that CON review ensures new facilities and services are aligned with demonstrated community need, helping to protect safety-net hospitals and maintain access to care in underserved areas. Supporters also point to the coordinated regulatory approach as a tool for promoting equitable distribution of healthcare resources across the state.
WHAT CRITICS ARGUE
Critics of Maryland’s CON laws argue that requiring state approval to open or expand healthcare facilities limits competition, which can reduce patient choice and potentially keep prices higher than they would be in a more open market. Opponents contend that incumbent healthcare providers can use the CON process to block new competitors from entering the market, effectively protecting established institutions at the expense of innovation and access. Some critics also argue that the extensive regulatory requirements create delays and increase administrative costs for providers seeking to offer new services.
The Data
WHAT THE DATA SHOWS IN MARYLAND
No CMS hospital comparison data is currently available for Maryland facilities in the dataset reviewed. However, Maryland’s healthcare market is notably distinct because of its all-payer global hospital budget system, which sets overall spending caps for hospitals — a model unique among U.S. states and one that operates in tandem with its full-scope CON program.
Recent Developments
Maryland’s CON law was last amended in 2023, reflecting ongoing legislative attention to the state’s healthcare regulatory framework. The state continues to operate its distinctive global hospital budget system alongside CON requirements, maintaining one of the most regulated healthcare markets in the nation. These combined regulatory structures remain a subject of policy discussion as lawmakers weigh the balance between cost control, access, and market competition.
What This Means For Patients in Maryland
For patients in Maryland, the CON law means that new healthcare facilities, major service expansions, and acquisitions of expensive medical equipment must receive state approval before proceeding, which can affect where and when new services become available. The combined effect of CON regulation and the global hospital budget system aims to manage costs and coordinate care, though patients may experience limited options in some areas if new providers face barriers to market entry.
THE BOTTOM LINE
Maryland maintains one of the nation’s most comprehensive healthcare regulatory environments, with a full-scope CON law and a unique global hospital budget system, and the debate continues over whether this framework best serves patients through cost control and planning or whether it limits competition and choice.
Frequently Asked Questions
Does Maryland have a Certificate of Need law?
Yes, Maryland has a full-scope Certificate of Need law that was enacted in 1978 and last amended in 2023. The law is administered by the Maryland Health Care Commission and requires state approval for a broad range of healthcare facility and service changes.
What services require CON approval in Maryland?
Maryland’s CON law covers hospitals, nursing homes, ambulatory surgery centers, imaging equipment such as MRI and CT scanners, dialysis facilities, hospice providers, psychiatric facilities, and home health agencies. This broad scope makes Maryland’s CON program one of the most comprehensive in the country.
How do Maryland CON laws affect hospital costs?
Maryland’s CON laws work alongside the state’s unique global hospital budget system, which caps overall hospital spending, creating a dual regulatory approach to managing healthcare costs. Proponents argue this framework controls spending, while critics contend it may limit competition that could otherwise drive down prices.
Can I find out if a facility has CON approval in Maryland?
Yes, the Maryland Health Care Commission oversees the CON process and maintains information about applications and approvals. Patients and the public can visit the agency’s website at https://mhcc.maryland.gov for details on CON filings and approved projects.