Indiana

Indiana requires CONs within three broad categories—hospital beds, beds outside hospitals, and facilities. The program targets “comprehensive care beds,” mainly beds in nursing homes, with minor provisions for comprehensive care beds in hospitals and intermediate care facilities for the intellectually disabled. Indiana has long maintained a CON for comprehensive care of ventilation-dependent, spinal, and HIV patients and began accepting applications under the nursing-home CON law on July 1, 2019. See Ind. Code §§ 16-29-2-5, -7-13(a). Indiana is the only state in the nation to have a single application cycle per year.  

Indiana’s COVID-19 Response 

On March 19, 2020, Governor Holcomb authorized the Commissioner of the Indiana Department of Health to “waive requirements of the nursing home certificate of need statute” as necessary to respond to COVID-19. Exec. Order 20-05 at 3 (Mar. 19, 2020).³⁴ A former statute, Ind. Code ch. 16-28-2.5, which had imposed a conditional moratorium on continuing care beds, expired no later than 30 days after the Department filed new regulations on May 15, 2020. As of that date, however, Commissioner Box had not responded to the Executive Order; the statute, Ind. Code § 16-2-7-19(b), prohibits the waiver of CON requirements. 

Application Process 

In Indiana, the CON application process takes about nine months. See Ind. Code § 16-29-7-13(e). Applications can only be submitted once annually through July 31. Ind. Code § 16-29-7-13(b). The fee for a CON application is $5,000. 410 Ind. Admin. Code § 40-5-1; Ind. Code § 16-29-7-19(a).³⁵ Competitors cannot intervene directly in the application process but they may submit public comments. See Ind. Code § 16-29-7-13(d). 

Types of CONs in Indiana 

	CON?	CON applies with expenditure of:	Temporary COVID-19 response:
Hospital Beds	Yes	–	–
Beds Outside Hospitals	Yes	Any amount	–
Equipment	No	–	–
Facilities/Buildings	Yes	Any amount	–
Services	No	–	–
Emergency Medical Transport	No	–	–

Indiana CONs in Detail 

Category	Types of CONs	Ind. Code
Hospital Beds	Ventilation-dependent, spinal, and HIV patient beds.	§ 16-29-2-5
	Hospitals may convert some acute beds to comprehensive care without a CON, but must license the comprehensive care beds if they exceed 50% of the beds in the hospital.	§ 16-29-3-1, -2
Beds Outside Hospitals	A bed in a comprehensive care health facility (nursing home) that is licensed or is to be licensed under Ind. Code § 16-28-2.	§§ 16-29-7-1(a)(1)(A), 16-29-7-2(a)(1)
	A bed in a comprehensive care health facility (nursing home) that functions as a bed licensed under Ind. Code § 16-28-2.  The conversion of existing health facility beds to ICF/IID beds.	§ 16-29-7-2(a)(2) § 16-29-7-4-1(1)
Equipment	No CONs in this category.
Facilities/Buildings	Construction of a new nursing home.  Modification or alteration of an existing nursing home. The construction of new ICF/IID facilities.	§§ 16-29-7-1(a)(2),  16-29-7-3(1)–(7) § 16-29-4-1(2)
Services	No CONs in this category.
Emergency Medical Transport	No CONs in this category.

Indiana CON Exceptions 

No CON Required For:	Ind. Code
A replacement facility in the same county as the original facility.	§ 16-29-7-1(a)(1)
A facility creating a new addition or altering the structure of the existing facility, if adding no beds from outside the county.	§ 16-29-7-1(a)(2)
Transferring beds to another facility in the same county.	§ 16-29-7-1(a)(3)
A care bed that is: owned by a religious organization or a nonprofit owned by a religious organization.	§ 16-29-7-1(a)(4)
A care bed that is sponsored by a fraternal organization.	§ 16-29-7-1(a)(5)
Small house facility with no more than 50 beds.	§ 16-29-7-1(a)(6)
A grandfathered continuing care retirement community that needs additional comprehensive care beds for purposes of fulfilling a continuing care contract.	§ 16-29-7-1(a)(7)

Indiana only began accepting applications on July 1, 2019.