Pennsylvania Healthcare Facility Licensure: Licensure Without CON

The statutory framework

• Health Care Facilities Act — the underlying PA statute.
• 28 Pa. Code 101 et seq. — facility licensure regulations.
• PA Department of Health Bureau of Facility Licensure and Certification — administering agency.
• No CON — the 1996 expiration means facility development is not gated by a need-determination process.

Primary source: health.pa.gov.

What facilities are licensed

Inpatient

• Hospitals.
• Nursing homes.
• Intermediate Care Facilities for persons with developmental disabilities.
• Hospice agencies (inpatient).

Outpatient

• Ambulatory surgical facilities.
• Birth centers.
• Comprehensive Outpatient Rehabilitation Facilities (CORFs).
• Home care agencies.
• Home health agencies.
• Kidney dialysis centers (ESRD).
• Outpatient physical / speech / occupational therapy clinics.
• Rural health clinics.
• Pediatric extended care centers.

The three-phase application process

1. Phase One — Initial review. DOH staff review the submitted application. Results may include authorization for exam, notice of missing information, or fee request.
2. Phase Two — Applicant response. Time for applicant or third parties to respond to application requirements: taking exams, providing educational documents, completing background checks, fulfilling training hours.
3. Phase Three — Complete-application review. Time between DOH's receipt of a complete application (including exam results, training confirmation, and background checks) and final decision to issue or deny a license.

Specific application forms and checklists are facility-type-specific. Facilities also licensed by the Department of Human Services must submit Civil Rights Compliance forms for initial and renewal applications.

Inspections

• Unannounced on-site surveys for compliance with state and federal health and safety standards (sanitation, fire safety, quality of care).
• Cadence — typically every 12-15 months as annual review, plus in response to specific complaints or adverse incident reports.
• Inspection teams — registered nurses, social workers, nutritionists, and other professionals depending on facility type. Multi-day evaluations.
• Violations — citations issued with required Plan of Correction response.

Renewals

• License renewal application on Department-prescribed form.
• Required fee plus updated annual financial report.
• Submitted at least 21 days before current license expires.
• Hospitals — typically 2-year license cycles.
• Other facility types — biennial in most cases.
• Provisional licenses — may be renewed up to three times at DOH discretion for facilities addressing remediation.

What "no CON" means in practice

Developers considering PA healthcare work get substantially more open-market conditions than in DE, NJ, MD, or VA:

• No need demonstration. Build because there's a business case, not because a state commission agrees.
• No batch cycles. Time-to-market is gated by construction, licensing, and local permits — not a state-batched review calendar.
• No incumbent opposition forum. Existing providers can't object through a state agency review; competition is market-based.
• No charity care conditions. PA doesn't impose service-obligation or charity-care conditions through a CON approval process (hospital community benefit obligations exist through other frameworks but not via CON).
• Still need licensure. Facility doesn't operate without DOH license. Licensure is substantive — code compliance, safety, clinical governance, staffing.
• Still need local permits and construction compliance. PA UCC (see our PA UCC essay), zoning through local MPC (see our PA MPC essay), prevailing wage on qualifying public work.

Commercial development effects

The practical consequence of no CON for PA healthcare real estate:

• Ambulatory surgery centers — PA sees substantially higher ASC development per capita than most CON states.
• Imaging centers — free-market development with no state-agency need review.
• Specialty hospitals and long-term acute care — deployable on business-case merits.
• Home health and hospice — lower barrier to entry; competitive market.
• Nursing homes — still subject to state and federal nursing-facility regulatory frameworks but no CON approval gate.

Research cited by various policy groups suggests healthcare costs are higher in CON states (roughly 11% by some estimates), and hospital charges have dropped following CON repeal in states that have removed the framework. The policy debate is ongoing; the practical effect in PA is that capital deployment in healthcare is less encumbered than in neighboring CON states.

What the absence of CON doesn't mean

• Licensure is still substantive. PA DOH reviews facility design against code, inspects operations, enforces quality standards. Not a rubber stamp.
• Federal CMS rules still apply. Medicare/Medicaid participation requirements, CMS surveys, Conditions of Participation.
• Local permits still apply. UCC, zoning, MPC procedures — all the standard PA construction regulatory stack.
• Financing is still a real gate. The market's need review happens via capital providers, not state commissions.

How PA's framework compares to neighbors

• Delaware CPR. HRB-administered CON-equivalent; $5.8M threshold. See our DE CPR essay.
• Maryland CON. MHCC + OHCQ separation; $12.4M hospital / $6.2M non-hospital thresholds. See our MD CON essay.
• New Jersey CN. Full/expedited review split with substantial exemptions. See our NJ CN essay.
• Virginia COPN. Seven batching groups, 120/190-day review. See our VA COPN essay.
• Pennsylvania. No CON. Facility licensure only.

For the broader cross-state view, see our Certificate of Need Across the Mid-Atlantic essay and CON vs Licensure Distinction essay.

What to do with this

If you're planning PA healthcare development: budget for facility licensure substantively but skip the CON timeline entirely. First-to-market advantages are real.

If you're crossing into PA from a CON state: internalize that market due diligence replaces state-agency need review. The need question is answered by capital and operating pro forma, not by a commission.

If you're operating in PA: maintain clean inspection history, renew on time (21 days before expiration), and track CMS certification parallel to state licensure.

If you're comparing multi-state portfolios: PA's structural difference affects time-to-market on every project type. Budget differently.

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