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Notice of Agency Change
On May 28, 2025, Gov. Kim Reynolds signed House File 972 which abolished the State Health Facilities Council and moves the Certificate of Need (CON) program under the Iowa Department of Health and Human Services (HHS). HHS will begin managing the CON program effective July 1, 2025.
Note: References to Iowa Code Chapter 10A and Iowa Administrative Code Chapters 2202 & 2203 will be updated pursuant to House File 972
Certificate of Need (CON) Overview
Certificate of Need (CON) is a process that requires HHS to review and approve CON applications prior to offering or developing a new or changed health service. New or changed health services requiring a CON and exclusions to CON are outlined in Iowa Code sections 10A.711 and 10A. 713. Potential applicants include hospitals, nursing facilities, ambulatory surgery centers, or anyone purchasing medical equipment costing more than $1.5 million.
The CON process is outlined in the Notice of Changes to Certificate of Need Process. (211.67 KB) .pdf
Back to topLaws & Rules
- Iowa Code sections 10A.711 - 10A.729
- Iowa Administrative Code 481 Ch. 2202 — Certificate of Need Program
- Iowa Administrative Code 481 Ch. 2203 — Standards for Certificate of Need Review
Public Hearings
- Each Application that has not requested a summary review will undergo a public hearing to gather stakeholder input.
- Details regarding scheduled hearings will be available on the Iowa HHS website.
- Iowa HHS will coordinate and facilitate hearings but will not engage in dialogue.
- Hearings will be scheduled for one hour unless otherwise determined.
- Participants will be allotted five minutes per turn to provide input.
Past Hearings
Letters of Intent and Applications on File
Letters of intent are kept on file for one year after the date of submission or update.
New Application
Applicant: Lucas County Health Center
Project: Purchase a fixed MRI scanner
Received: March 11, 2026
City: Chariton | County: Lucas
Estimated Cost: $2,545657
Affected parties should submit letters of support or opposition by April 2, 2026 to CertificateOfNeed@hhs.iowa.gov
- Applicant: Kossuth Regional Health Center
Project: Purchase of a da Vinci 5 Single Console System
Received: March 30, 2026
City: Algona | County: Kossuth
Estimated Cost: $2,498,902 - Applicant: Orthopedic Ambulatory Surgical Center
Project: Establish an orthopedic ambulatory surgery center
Received: March 27, 2026
City: Grimes | County: Polk
Estimated Cost: $25,000,000 - Applicant: Shenandoah Medical Center
Project: Purchase of a fixed MRI system
Received: February 24, 2026
City: Shenandoah| County: Page
Estimated Cost: $3,927,981 - Applicant: UnityPoint Health - Sioux City
Project: Re-open Cardiothoracic Surgery Service Unit
Received: February 17, 2026
City: Sioux City | County: Sioux City
Estimated Cost: $730,000 - Applicant: Stewart Memorial Clinic
Project: Build a new rural health clinic to expand services
Received: January 27, 2026
City: Rockwell City | County: Calhoun
Estimated Cost: $5,807,454 - Applicant: Southeast Iowa Regional Medical Center
Project: Bed increase of 5 acute care beds. Increase from 263 to 268
Received: January 27, 2026
City: West Burlington | County: Des Moines
Estimated Cost: $0 - Applicant: Unity Healthcare DBA Trinity Muscatine
Project: Purchase and install a da Vinci 5 (DV5) robotic surgical system
Received: January 23, 2026
City: Muscatine | County: Muscatine
Estimated Cost: $2,300,000 - Applicant: Cardiology Consultants
Project: Establish cardiac catheterization service
Received: Feb. 5, 2025
City: Clinton | County: Clinton
Estimated Cost: $3,350,000
Applicant: St. Luke's (Jones RMC)
Project: Purchase and install a da Vinci 5 (DV5) robotic surgical system
Received: February 15, 2026
City: Anamosa | County: Jones
Estimated Cost: $3,886,000
Application (120.52 KB) .pdf
Applicant: Mahaska Health Partnership
Project: Purchase a PET/CT Scanner
Received: February 23, 2026
City: Oskaloosa | County: Mahaska
Estimated Cost: $4,493,861
Application (118.12 KB) .pdf
Applicant: Southeast Iowa Regional Medical Center
Project: Bed increase of 5 acute care beds. Increase from 263 to 268
Received: March 4, 2026
City: West Burlington | County: Des Moines
Estimated Cost: $0
Applicant: Crystal Heights Care Center
Project: Bed increase of 13 ICF beds from 72 to 85.
Received: March 5, 2026
City: Oskaloosa | County: Mahaska
Estimated Cost: $0
Applicant: Hancock County Health System
Project: Purchase of a fixed MRI System
Received: March 6, 2026
City: Britt | County: Hancock
Estimated Cost: $1,899,887
Applicant: Belmond Community Hospital
Project: Purchase of DaVinci 5 Robotic System
Received: March 6, 2026
City: Belmond | County: Wright
Estimated Cost: $4,951,000
Applicant: Crawford County Memorial Hospital
Project: Purchase of a fixed MRI System
Received: March 6, 2026
City: Denison | County: Crawford
Estimated Cost: $1,732,467
Applicant: Manning Regional Healthcare Center
Project: Purchase of a fixed MRI System
Received: March 9, 2026
City: Manning | County: Carroll
Estimated Cost: $2,400,000
Applicant: Greater Regional Health
Project: Purchas DaVinci Robotic Surgical System
Received: March 11, 2026
City: Creston | County: Union
Estimated Cost: $2,865,000
Applicant: Waverly Health Center
Project: Purchase da Vinci Robotic System
Received: March 17, 2026
City: Waverly | County: Bremer
Estimated Cost: $2,801,656
The Department of Health and Human Services (HHS) will post projects on its website that are scheduled to expire 30 days prior to the expiration date of their certificate of need (CON) approval. Pursuant to Iowa Code section 10A.721, any affected person has the right to submit information which may be relevant to the question of granting an extension. This information may be submitted to the Certificate of Need mailbox at certificateofneed@hhs.iowa.gov. Such comments must be received prior to the expiration date to be considered.
- Applicant: Ellsworth Municipal Hospital
Project: Purchase a Da Vinci robotic-assisted surgical system
Received: December 18, 2025
City: Iowa Falls | County: Hardin
Decision Issued: March 11, 2026 - Applicant: Hegg Memorial Hospital
Project: Acquire MRI equipment
Received: February 10, 2025
City: Rock Valley | County: Sioux
Decision Issued: March 11, 2026 - Applicant: Cass County Memorial Hospital
Project: Purchase a PET/CT System and general renovation
Received: January 7, 2025
City: Atlantic | County: Cass
Decision Issued: February 9, 2026 - Applicant: Clear Lake Surgical Center
Project: Establish an ambulatory surgical center
Received: October 10, 2025
City: Clear Lake | County: Cerro Gordo
Decision Issued: January 6, 2026 - Applicant: Floyd Valley Healthcare
Project: Purchase of Equipment DaVinci Xi Robot Surgery System
Received: October 30, 2025
City: Le Mars | County: Plymouth
Decision Issued: January 6, 2026 - Applicant: On with Life
Project: 2 bed expansion
Received: November 5, 2025
City: Ankeny | County: Polk
Decision Issued: January 6, 2026 - Applicant: Sioux Center Health
Project: Purchase of Equipment DaVinci Xi Robot Surgery System
Received: September 25, 2025
City: Sioux City | County: Sioux County
Decision Issued: October 20, 2025 - Applicant: St. Anthony Regional Hospital
Project: Purchase and Installation of a Fixed PET/CT Scanner
Received: August 21, 2025
City: Carrol | County: Carroll
Decision Issued: September 24, 2025 - Applicant: Orange City Area Health System
Project: Purchase Di Vinci Surgical Robot
Received: July 19, 2025
City: Orange City | County: Sioux
Decision Issued: September 4, 2025 - Applicant: Surgical Partners of Iowa
Application Received: March 12, 2025
Project: Establish an ambulatory surgical center and clinic
City: Urbandale | County: Dallas
Decision Issued: August 15, 2025 - Applicant: Northwest Iowa Ambulatory Surgery Center (NW ASC)
Application Received: March 12, 2025
Project: Establish an ambulatory surgical center
City: Orange City | County: Sioux
Decision Issued: June 23, 2025 Rehearing Decision Issued: September 4, 2025 - Applicant: CCRC of Tiffin, LLC
Application Received: May 18, 2023
Project: 40 Bed Nursing Facility
City: Tiffin | County: Johnson
Extension Issued: June 23, 2025 - Applicant: UnityPoint Health, Waterloo Allen Hospital
Application Received: July 17, 2024
Project: Allen Project Third Cardiac Catheterization Lab
City: Waterloo | County: Black Hawk
Extension Issued: June 23, 2025 - Applicant: Oaknoll Retirement Residence
Application Received: March 11, 2024
Project: Addition of 12 Licensed Nursing Beds
City: Iowa City | County: Johnson
Extension Issued: June 23, 2025
- Applicant: Winneshiek County Medical Hospital d/b/a WinnMed
Project: Purchase Di Vinci Surgical Robot
Received: July 15, 2025
City: Decorah | County: Winneshiek
Project Closed: February 10, 2026 - Applicant: UnityPoint Health, Iowa Methodist Medical Center
Application Received: March 12, 2025
Project: Acquisition of Equipment DaVinci Xi Robot Surgery System
City: Des Moines | County: Polk
Project Closed: January 6, 2026 - Applicant: Southeast Iowa Behavioral Healthcare Center (SIBHC)
Project: Convert 16 existing intermediate care facilities (ICF) / for person with mental illness(PMI) beds to nursing facility beds.
Received: August 27, 2025
City: Keokuk| County: Lee
Project Closed: March 16, 2026 - Applicant: Southeast Iowa Regional Medical Center
Project: Purchase Di Vinci Surgical Robot
Received: August 6, 2025
City: West Burlington | County: Des Moines
Project Closed: March 17, 2026
Submission Guidelines
- Before applying for a certificate of need (CON), the sponsor of a proposed new institutional service or changed institutional health service shall submit to HHS, a letter of intent to offer or develop a service requiring a certificate of need.
- Letters of intent must be submitted to the department not less than 30 days prior to the submission of an application for a CON.
- The Department of Inspections, Appeals, and Licensing's (DIAL) Health and Safety Division reviews and approves all facility bed increases prior to issuing a new or amended license. If you will be submitting a CON application for a facility that will have a nursing facility or hospital license, notification to the department at the time the letter of intent is filed is highly recommended. Contact the DIAL Health and Safety Division for more information. In addition, nursing home beds have to be approved for compliance by the State Fire Marshal’s Office. Please contact them in advance of submitting your application to describe your project.
- Letters of intent should be submitted as soon as possible after initiation of the planning process and before substantial expenditures are made.
- Letters of intent shall include the following information:
- A brief description of the proposed project, including facility name and sponsor;
- The project’s location, including county; and
- The project’s estimated cost (site costs, land improvements, facility costs, and movable equipment).
Note: A CON application may not be accepted if the information contained in the application materially differs from the information provided in the letter of intent (i.e., facility name; sponsor; capital expenditure; and location, including county).
- Letters of intent are valid for one year from the date they are received by the department. The sponsor may renew the validity of a letter of intent by providing written notification to the department prior to the one-year expiration date.
- Submit letters of intent
- Upon receipt of a letter of intent the department will issue a letter of response. Please keep this letter for further reference.
- A list of active letters of intent is posted on the CON website.
- For more information contact CON staff.
PLEASE READ PRIOR TO COMPLETING AN APPLICATION
Reviewability Determination
If the reviewability of a project is in question a Reviewability Determination may be requested prior to the submission of an application. See IAC 481—2202.3 for more information and/or contact CON staff at CertificateOfNeed@hhs.iowa.gov.
NOTE: If a Reviewability Determination results in having to file a CON application, the applicant may apply as soon as they receive the determination.
Moratorium on new Nursing Facilities
As of July 1, 2023, there is a moratorium on new nursing facility beds until June 30, 2026. [Iowa Code Chapter 135C.35A]. If a nursing facility would like to seek a waiver from the moratorium they must submit a request to the CON staff at CertificateOfNeed@hhs.iowa.gov.
NOTE: If a Moratorium request results in an approval, the applicant may apply as soon as they receive the approval.
Guidelines on How to Apply for Certificate of Need
- Prior to completing an application, review Iowa Code sections 10A.711 - 729 and Iowa Administrative Code (IAC) 481—chapters 2202 and 2203. These materials will provide information about Certificate of Need (“CON”) and the application process.
- The applicant will file an electronic copy of the entire application (including any attachments). Certificate of Need Application Form
- Once the application is submitted the applicant will receive information on how to electronically pay the appropriate CON filing fee, per section Iowa Code section 135.63.
PLEASE NOTE: ICF/ID’s and ICF/PMI’s are exempt from the CON filing fee.
- CON staff will review the application for completeness upon receipt. Within fourteen (14) days of acceptance, the application will be deemed complete, or a request for additional information will be issued.
- If a request for additional information is issued, responses to the questions must be made in writing and delivered electronically to CertificateOfNeed@hhs.iowa.gov.
- Affected party letters in support or opposition can be submitted to the applicant or to CertificateOfNeed@hhs.iowa.gov.
- An applicant may withdraw its application at any time without prejudice. Application fees are subject to refund based on the schedule listed in IAC 481— 2202.4(2)(b). It is the responsibility of the applicant to notify CON staff regarding whom the refund check should be made to and where it should be sent.
- The application, other materials in the project file and any evidence offered at the public hearing are considered public record and are available for public inspection, copying, and disclosure under Iowa Open Records Law – Iowa Code Chapter 22.
An affected party may submit a letter of support or opposition to a specific project, appear at the public hearing to provide oral testimony either in support or opposition, or both. An affected party is not required to submit written testimony in order to appear as an affected party at the public hearing. Neutral letters can also be provided. Public hearings can be found on the Public Meetings Calendar.
Iowa Administrative Code (IAC) 481—2202.1.
NOTE: Any dissatisfied party who is an affected person with respect to the application, may request a rehearing in accordance with Iowa Code chapter 17A and rules of the department. If a rehearing is not requested or an affected party remains dissatisfied after the request for rehearing, an appeal may be taken in the manner provided by Iowa Code chapter 17A.
Application and Other Forms
Please carefully review the purpose of your submission before selecting a form. If you are submitting a Certificate of Need (CON) Application, a complete application requires payment of the processing fee to be considered a project. All CON applications must include either a Reviewability Determination or Letter of Intent submitted at least 30 days prior to the full application. Additional forms are included below related to the Certificate of Need Program (e.g., Extension Request, Reduction in Bed Capacity, etc.). These forms do not require a fee. Selecting the correct form helps avoid delays.
Other Information
- Long-term care bed need formula spreadsheet (Jan. 2023)
Projects Reviewed by the State Health Facilities Council
FY 2025 Projects (148.5 KB) .pdf
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