Alaska

Alaska requires CONs within five broad categories—hospital beds, beds outside  
hospitals, equipment, facilities and services. Alaska is the only state that maintains a standard minimum expenditure of $1.5 million across all of its CONs, meaning none of its CON requirements are triggered until: (1) an individual or facility proposes a project or service covered by a CON and (2) the project or service will cost more than $1.5 million. Alaska Stat. § 18.07.031(a), (d). CON application fees in Alaska can cost as much as $75,000. 7 Alaska Admin. Code § 07.079. 

Alaska’s COVID-19 Response  

On April 14, 2020, Governor Dunleavy extended an order allowing hospitals to temporarily increase bed capacity without a CON to respond to COVID-19. See Amendment 3 (Apr. 14, 2020)²² to COVID-19 Disaster Order No. 2 (Mar. 31, 2020). The Governor’s temporary CON suspension expired on May 12, 2020.  

Application Process  

In Alaska, the CON applications are reviewed within 60–90 days of completion. Alaska Stat. § 18.07.045. Applications can be submitted at any time. The fee for a CON application ranges from $2,500 to $75,000. 7 Alaska Admin. Code § 07.079. Competitors can provide public comment during the application process and can offer evidence or argument as to why an application should be denied. 7 Alaska Admin. Code § 07.052(b)(7).  

Types of CONs in Alaska  

	CON?	CON applies with expenditure of:	Temporary  COVID-19 response:
Hospital Beds	Yes	$1.5 million+	Suspended
Beds Outside Hospitals	Yes	$1.5 million+	–
Equipment	Yes	$1.5 million+	–
Facilities/ Buildings	Yes	$1.5 million+	–
Services	Yes	$1.5 million+	–
Emergency Medical Transport	No	-	–

Alaska CONs in Detail 

Category	Types of CONs	Alaska Stat.
Hospital Beds A CON is required if a change in the following types of bed is made that costs more than $1.5 million.  Alaska Stat.  § 18.07.031(a), (d)	Alteration of the bed capacity of: Private hospital.  Municipal hospital.  State hospital.   Federal hospital. Psychiatric hospital.	§ 18.07.111(8)
	Tuberculosis hospital.	§§ 18.07.031(a)(2),  18.07.111(8)
	Acute care hospital.	7 Alaska Admin.   Code § 07.900(19)(B)(i)
	Critical access hospital.	7 Alaska Admin.   Code § 07.900(19)(B)(iii)
Beds Outside Hospitals  A CON is required if a change in the following types of bed is made that costs more than $1.5 million.  Alaska Stat.  § 18.07.031(a), (d)	Alteration of the bed capacity of a: Independent diagnostic testing facility.   Residential psychiatric treatment center.  Skilled nursing facility. Kidney disease treatment center (including freestanding hemodialysis units).  Intermediate care facility.  Ambulatory surgical facility.	§ 18.07.111(8)
Equipment	Positron emission tomography.	Alaska CON Standards and Methodology, VII, B (Dec. 9, 2005)23
	Computed tomography.	Alaska CON Standards and Methodology, VII, C
	Magnetic resonance imaging.	Alaska CON Standards and Methodology, VII, A
Category	Types of CONs	Alaska Stat.
Facilities/Buildings  A CON is required if the construction of a facility will cost more than   $1.5 million. Alaska Stat. § 18.07.031(a), (d)	Private hospital.  Municipal hospital.   State hospital.   Federal hospital.   Psychiatric hospital.	§ 18.07.111(8)
	Independent diagnostic testing facility.  Residential psychiatric treatment center.  Tuberculosis hospital.  Skilled nursing facility. Kidney disease treatment center (including freestanding hemodialysis units).  Intermediate care facility. Ambulatory surgical facility.	§§ 18.07.031(a)(1),   18.07.111(8)
	Conversion of a building or part of a building to a nursing home, regardless of cost.	See § 18.07.031(b)
	Construction of an acute care hospital.	§ 18.07.031(a)(1);  7 Alaska Admin Code § 07.900(19)(B)(i)
	Construction of a critical access hospital.	§ 18.07.031(a)(1);  7 Alaska Admin. Code   § 07.900(19)(B)(iii)
Services  A CON is required if the following facilities add services that cost more than $1.5 million.  Alaska Stat.  § 18.07.031(a), (d)	Addition of a category of health services provided by a: Private hospital. Municipal hospital. State hospital. Federal hospital.	§§ 18.07.031(a)(3),  18.07.111(8)
	Kidney dialysis program. Radiotherapy. Burn unit. Neonatal intensive care services.	§ 18.07.111(1)
	Laboratory services offered by a hospital.	Alaska CON Standards and Methodology, III, A.
	Cardiac catheterization.	Alaska CON Standards and Methodology, VII, D.
	Mobile diagnostic testing facility.	See 7. Alaska Admin. Code  § 07.900(23)
	Open-heart surgery.	Alaska CON Standards and Methodology, VIII, B
	Addition of a category of health services provided by an acute care hospital.	§ 18.07.031(a)(3);  7 Alaska Admin. Code  § 07.900(19)(B)(i)
Category	Types of CONs	Alaska Stat.
Services  A CON is required if the following facilities add services that cost more than $1.5 million.  Alaska Stat.  § 18.07.031(a), (d)	Addition of a category of health services provided by a critical access hospital.	§ 18.07.031(a)(3);  7 Alaska Admin. Code   § 07.900(19)(B)(iii)
	Addition of a category of health services provided by a psychiatric hospital.	§ 18.07.031(a)(3);  7 Alaska Admin. Code   § 07.900(19)(B)(ix)
	Addition of a category of health services provided by an independent diagnostic testing facility.	§§ 18.07.031(a)(3),   18.07.111(8)
	Addition of a category of health services provided by a: Residential psychiatric treatment center.  Addition of a category of health services provided by a tuberculosis hospital.  Addition of a category of health services provided by a skilled nursing facility.  Addition of a category of health services provided by a kidney disease treatment center (including freestanding hemodialysis units).  Addition of a category of health services provided by an intermediate care facility.  Addition of a category of health services provided by an ambulatory surgical facility.	§§ 18.07.031(a)(3),   18.07.111(8)
Emergency Medical Transport	No CONs in this category.

 Alaska CON Exceptions 

No CON Required For:	Alaska Stat.
The Alaska Pioneers’ Home and the Alaska Veterans’ Home administered by the Department of Health and Social Services under Alaska Stat. 47-55.	§ 18.07.111(8)(A)
The offices of private physicians or dentists whether in individual or group practice.	§ 18.07.111(8)(B); 7 Alaska Admin. Code  § 07.001(b)
The operator of an ambulatory surgical facility may relocate to a new site in the same community as long as the bed capacity and number of categories of health services provided at the new site stay the same.	§ 18.07.031(c)
The operator of an ambulatory surgical facility may make an expenditure of any amount in order to relocate to a new site in the same community as long as the bed capacity and number of categories of health services provided at the new site stay the same.	§ 18.07.031(c)