Tennessee lawmakers are advancing another rewrite of the state’s Certificate-of-Need (CON) framework, though this time the effort is aimed mostly at hospitals and hospital-adjacent services rather than ambulatory surgery centers (ASCs) directly.
House Bill 0819 and Senate Bill 1369 would remove CON requirements for acute care hospitals, satellite emergency departments and cardiac catheterization services.
Under the amended legislation, the acute care hospital CON repeal would take effect July 1, 2030, while the satellite ED and cardiac cath provisions would take effect July 1, 2028. The bill also adds licensing guardrails for newly licensed acute care hospitals, including potential requirements tied to TennCare participation and charity care.
“Present law generally requires that a person obtain a certificate of need to establish a hospital, other than a mental health hospital,” a legislative summary states. “Effective July 1, 2028, this bill adds that a certificate of need will not be required to establish an acute care hospital, which this bill defines to mean a hospital with a primary focus on patients with an average length of stay of 25 days or less.”
As of the latest legislative action, the House substituted the Senate bill for HB 0819 and passed it with amendments on April 13. The Senate then concurred with those House amendments on April 16, putting the measure through both chambers and effectively to the doorstep of final executive action.
For ASC operators, the bill is relevant even though it is not an ASC bill on its face.
It signals that Tennessee continues to move away from traditional CON controls and toward a more permissive market structure for health care capacity. That matters because changes affecting hospitals, satellite emergency departments and cardiac cath services can reshape referral flows, physician alignment and competition for outpatient cases.
In other words, even ASCs are not main characters of the story here, they are still in the book.
Tennessee already passed legislation in 2024 eliminating CON requirements for ambulatory surgery centers licensed on or after Dec. 1, 2027.
Until then, Tennessee remains a CON state for ASCs. After that date, new ASCs will no longer need CON approval to operate, though licensure and other regulatory requirements will remain.
As a side note, both votes in the House and Senate were overwhelmingly in support of the legislation. Local news outlets have additional coverage on the legislative effort.
