Illinois
Illinois requires CONs within five broad categories—hospital beds, beds outside hospitals, equipment, facilities and services. If no specific CON applies, catch-all CONs are required if: (1) a hospital proposes a project that will cost more than $13,743,450; (2) a long-term care facility proposes any project that will cost more than $7,768,030; or (3) any other facility proposes any project that will cost more than $3,585,250. See 77 Ill. Admin. Code § 1130.310(a)(1); 20 ILCS 3960/3.
Illinois’ COVID-19 Response
As of May 15, 2020, Governor Pritzker had not suspended CON requirements in response to COVID-19. The Health Facilities and Services Review Board (Board), however, indicated that an emergency rule allowing the temporary addition of beds was in effect during the COVID-19 pandemic. See Board, Frequently Asked Questions and Answers for Health Care Facilities (Apr. 20, 2020). Under the emergency rule, healthcare facilities can temporarily increase bed capacity to accommodate extraordinary needs due to pandemics or other disasters so long as they provide written notice to the Board within 30 days of the decision to increase capacity. See 77 Ill. Adm. Code § 1130.240(f)(4)(A).
Application Process
In Illinois, the CON application process takes up to 120 days. 20 ILCS 3960/6.2. Applications can be submitted at any time. The non-refundable fee for a CON application ranges from $2,500 up to $100,000 depending on the cost of the proposed project. 77 Ill. Admin. Code § 1130.230(h)(2)(C)–(D). Competitors can request public hearings, at which they can offer evidence and argument as to why an application should be denied. 20 ILCS 3960/6.2.
Types of CONs in Illinois
| CON? | CON applies with expenditure of: | Temporary COVID-19 response: | |
| Hospital Beds | Yes | Any amount | Preexisting regulation implemented |
| Beds Outside Hospitals | Yes | Any amount | Preexisting regulation implemented |
| Equipment | Yes | $0 – $3,585,250+ | – |
| Facilities/Buildings | Yes | Any amount | – |
| Services | Yes | $0 – $3,585,250+ | – |
| Emergency Medical Transport | No | – | – |
Illinois CONs in Detail
| Category | Types of CONs | Citation |
| Hospital Beds Increasing the total number of beds, distributing beds or relocating beds from one facility to another by more than 20 beds or 10% of the total bed capacity, whichever is less, over a two-year period. 20 ILCS 3960/5(c) | Hospital beds. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (2)) |
| Hospital beds in a state-operated facility. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (4)) | |
| Beds Outside Hospitals Increasing the total number of beds, distributing beds or relocating beds from one facility to another by more than 20 beds or 10% of the total bed capacity, whichever is less, over a two-year period. 20 ILCS 3960/5(c) | Beds used in ambulatory surgical treatment centers. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (1)) |
| Beds used in a state-operated ambulatory surgical treatment center. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (4)) | |
| Beds used in long-term care nursing facilities. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (3)) | |
| Beds used in a state-operated nursing facility. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (4)) | |
| Beds used in facilities providing care for intellectual or developmental disabilities. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (3.5)) | |
| Beds used in facilities providing mental health rehabilitation. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (3.7)) | |
| Beds used in a kidney disease treatment center. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (5)) | |
| Beds used in state-operated kidney disease treatment centers. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (4)) | |
| Beds used in outpatient treatment centers that are owned or operated by an out-of-state facility. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (6)) | |
| Beds in any facility or room used for cardiac catheterization. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (7)) | |
| Beds in any facility or room used for open heart surgery. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (7)) | |
| Beds in any facility or room used for pediatric care. | 20 ILCS 3960/3 (“[h]ealth care facilities,” definition (7)); see 77 Ill. Admin. Code § 1100.200 | |
| Beds used in any facility or room housing equipment which is used for diagnosis or treatment and exceeds the capital expenditure minimum. | 20 ILCS 3960/3 (“[h]ealth care facility,” definition (8)) | |
| Category | Types of CONs | Citation |
| Equipment | The acquisition of major medical equipment costing more than $13,743,450 (hospital applicants), $7,768,030 (long-term care applicants), or $3,585,250 (other applicants), as updated annually. | 20 ILCS 3960/3 (“[m]ajor medical equipment” and “ 1 apital expenditure minimum” definitions); 77 Ill. Admin. Code § 1130.310(a)(7); see Memo from Board, Revised CON Review Thresholds (July 1, 2019)33 |
| Facilities/Buildings The establishment of any “health care facility” requires a CON. 20 ILCS 3960/3, 5 | Any substantial change to the scope of functional operation of the facility. | 77 Ill. Admin. Code §§ 1130.310(a)(2), 1130.140 |
| Hospital licensed under the Hospital Licensing Act. Ambulatory surgical treatment center licensed under the Ambulatory Surgical Treatment Center Act. Long-term care facility licensed under the Nursing Home Care Act. Developmental-disability care facility licensed under the ID/DD Community Care Act or the MC/DD Act. Facility licensed under the Specialized Mental Health Rehabilitation Act of 2013. Kidney disease treatment centers licensed under the End Stage Rental Disease Facility Act. Facility used for outpatient surgical procedures owned or operated by out-of-state facilities. Facility for the provision of any health care category of service defined by regulation. Facility used for provision of major medical equipment used in the direct clinical diagnosis or treatment of patients, and whose project cost is in excess of the capital expenditure minimum. | 77 Ill. Admin. Code §§ 1130.310(a)(3), 1130.215 | |
| A change of ownership of a health care facility, unless an exemption is issued. | 77 Ill. Admin. Code § 1130.310(a)(5) | |
| The discontinuation of an entire health care facility, unless an exemption has been issued. | 77 Ill. Admin. Code § 1130.310(a)(6) | |
| Services The initiation of any “category of service,” as authorized to be defined by the Board, requires a CON. 20 ILCS 3960/3, 5 | Acute mental illness treatment services. Ambulatory care. Birth center services. Cardiac catheterization. Cardiovascular surgery. Chronic renal dialysis. Community-based residential rehabilitation. Comprehensive physical rehabilitation. Emergent care. Extracorporeal circulation. Freestanding emergency center medical services. General long-term care. Hospital services that schedule surgical procedures on an inpatient basis. In-center hemodialysis. | 77 Ill. Admin. Code §§ 1130.215(i), 1100.220, 1110.200 et seq. (enumerating various categories of services) |
| Services | Intensive care service. Kidney transplants. Maternity care. Medical-surgical service. Neonatal intensive care service. Non-hospital (outpatient) ambulatory surgery. Obstetrics/gynecological care. Obstetrics service. Open heart surgery. Pediatric catheterization. Pediatric service. Postsurgical recovery care center alternative health care model. Selected organ transplantation service. Long-term care specializing in chronic mental illness. Long-term care specializing in care for developmentally disabled adults. Long-term care specializing in care for developmentally disabled children. Subacute care. Any project requiring a total capital expenditure in excess of $13,743,450, as updated annually, at a hospital. Any project requiring a total capital expenditure in excess of $7,768,030, as updated annually, at a long term care facility. Any project requiring a total capital expenditure in excess of $3,585,250, as updated annually, at any other facility. | 77 Ill. Admin. Code §§ 1130.215(i), 1100.220, 1110.200 et seq. (enumerating various categories of services) |
| Emergency Medical Transport | No CONs in this category. |
Illinois CON Exceptions
| No CON Required For: | Citation |
| Change of ownership of an existing health care facility, not including nursing homes. | 77 Ill. Admin. Code § 1130.410(a) |
| Discontinuation of an existing health care facility or category of service, other than a health care facility maintained by the state or any nursing home maintained by a county. | 77 Ill. Admin. Code § 1130.410(b) |
| A proposed project to establish or expand service or beds at a neonatal intensive care facility. | 77 Ill. Admin. Code §§ 1130.410(c), .531 |
| Federally-owned facilities. Facilities used solely for healing by prayer or spiritual means. Campus facilities as defined in Section 5-5.8b of the Illinois Public Aid Code. Facilities licensed under the Supportive Residences Licensing Act or the Assisted Living and Shared Housing Act. Facilities designated as supportive living facilities that are in good standing with the program established under Section 5-5.01a of the Illinois Public Aid Code. Facilities established and operating under the Alternative Health Care Delivery Act as a children’s community-based health care center alternative health care model demonstration program or as an Alzheimer’s Disease Management Center alternative health care model demonstration program. | 20 ILCS 3960/3 |