Code of Alabama

Ala. Code § 22-21-260 (2026)

Definitions.

✓ official Alabama Legislature (ALISON) text, current July 2026

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As used in this article, the following words and terms, and the plurals thereof, shall have the meanings ascribed to them in this section, unless otherwise required by their respective context:

(1) ACQUISITION. Obtaining the legal equitable title to a freehold or leasehold estate or otherwise obtaining the substantial benefit of such titles or estates, whether by purchase, lease, loan or suffrage, gift, devise, legacy, settlement of a trust or means whatever, and shall include any act of acquisition. The term “acquisition” shall not mean or include any conveyance, or creation of any lien or security interest by mortgage, deed of trust, security agreement, or similar financing instrument, nor shall it mean or include any transfer of title or rights as a result of the foreclosure, or conveyance or transfer in lieu of the foreclosure, of any such mortgage, deed of trust, security agreement, or similar financing instrument, nor shall it mean or include any gift, devise, legacy, settlement of trust, or other transfer of the legal or equitable title of an interest specified hereinabove by a natural person to any member of such person’s immediate family. For the purposes of this section “immediate family” shall mean the spouse of the grantor or transferor and any other person related to the grantor or transferor to the fourth degree of kindred as such degrees are computed according to law.

(2) APPLICANT. Any person, as defined in this section, who files an application for a certificate of need.

(2.1) CAMPUS. The contiguous real property, contained within a single county, which is owned or leased by a health care facility and upon which is located the buildings and any other real property used by the health care facility to provide existing institutional health services which are subject to review.

(3) CAPITAL EXPENDITURE. An expenditure, including a force account expenditure (i.e., an expenditure for a construction project undertaken by the health care facility as its own contractor), which, under generally accepted accounting principles, is not properly chargeable as an expense of operation and maintenance and which satisfies any of the following:

a. Exceeds two million dollars ($2,000,000) indexed annually for inflation for major medical equipment; eight hundred thousand dollars ($800,000) for new annual operating costs indexed annually for inflation; four million dollars ($4,000,000) indexed annually for inflation for any other capital expenditure. The index referenced in this paragraph shall be the Consumer Price Index Market Basket Professional Medical Services index as published by the U.S. Department of Labor, Bureau of Labor Statistics. The SHPDA shall publish this index information to the general public.

b. Changes the bed capacity of the facility with respect to which such expenditure is made.

c. Substantially changes the health services of the facility with respect to which such expenditure is made.

(4) CONSTRUCTION. Actual commencement, with bona fide intention of completing the construction, or completion of the construction, erection, remodeling, relocation, excavation, or fabrication of any real property constituting a facility under this article, and the term construct shall mean and include any act of construction. “Ground breaking ceremony,” “receipt of bids,” “receipt of quotation,” or similar action that will permit unilateral termination without penalty shall not be considered construction.

(5) FIRM COMMITMENT or OBLIGATION. Any of the following:

a. Any executed, enforceable, unconditional written agreement or contract not subject to unilateral cancellation for the acquisition or construction of a health care facility or purchase of equipment therefor.

b. Actual construction of facilities peculiarly adapted to the furnishing of one or more particular services and with the bona fide intention of furnishing such service or services.

c. Any executed, unconditional written agreement not subject to unilateral cancellation for the bona fide purpose of furnishing one or more services.

(6) HEALTH CARE FACILITY. General and specialized hospitals, including tuberculosis, psychiatric, long-term care, and other types of hospitals, and related facilities such as, laboratories, out-patient clinics, and central service facilities operated in connection with hospitals; skilled nursing facilities; intermediate care facilities; skilled or intermediate care units operated in veterans’ nursing homes and veterans’ homes, owned or operated by the State Department of Veterans’ Affairs, as these terms are described in Chapter 5A (commencing with Section 31-5A-1) of Title 31, rehabilitation centers; public health centers; facilities for surgical treatment of patients not requiring hospitalization; kidney disease treatment centers, including free-standing hemodialysis units; community mental health centers and related facilities; alcohol and drug abuse facilities; facilities for the developmentally disabled; hospice service providers; and home health agencies and health maintenance organizations. The term health care facility shall not include the offices of private physicians or dentists, whether for individual or group practices and regardless of ownership, or Christian Science sanatoriums operated or listed and certified by the First Church of Christ, Scientist, Boston, Massachusetts, or a veterans’ nursing home or veterans’ home owned or operated by the State Department of Veterans’ Affairs, not to exceed 150 beds to be built in Bay Minette, Alabama, and a veterans’ nursing home or veterans’ home owned or operated by the State Department of Veterans’ Affairs not to exceed 150 beds to be built in Huntsville, Alabama, for which applications for federal funds under federal law are being considered by the U.S. Department of Veterans’ Affairs prior to March 18, 1993.

(7) HEALTH SERVICE AREA. A geographical area designated by the Governor, as being appropriate for effective planning and development of health services.

(8) HEALTH SERVICES. Clinically related (i.e., diagnostic, curative, or rehabilitative) services, including alcohol, drug abuse, and mental health services customarily furnished on either an in-patient or out-patient basis by health care facilities, but not including the lawful practice of any profession or vocation conducted independently of a health care facility and in accordance with applicable licensing laws of this state.

(9) INSTITUTIONAL HEALTH SERVICES. Health services provided in or through health care facilities or health maintenance organizations, including the entities in or through which such services are provided.

(9.1) MAJOR MEDICAL EQUIPMENT. Medical clinical equipment intended for use in the diagnosis or treatment of medical conditions, which is used to provide institutional health services of a health care facility which are subject to review, and which expenditure exceeds the thresholds referenced in this section and in Section 22-21-263.

(10) MODERNIZATION. The alteration, repair, remodeling, and renovation of existing buildings, including equipment within the existing buildings. Modernization does not include the replacement of existing buildings which are used by a health care facility to provide institutional health services which are subject to review and does not include the replacement of major medical equipment.

(11) PERSON. Any person, firm, partnership, association, joint venture, corporation, limited liability company, or other legal entity, the State of Alabama and its political subdivisions or parts thereof, and any agencies or instrumentalities and any combination of persons herein specified, but person shall not include the United States or any agency or instrumentality thereof, except in the case of voluntary submission to the regulations established by this article.

(12) RURAL HEALTH CARE PROVIDER/APPLICANT/HOSPITAL. A provider or applicant or hospital which is designated by the United States government Health Care Financing Administration as rural.

(13) STATE HEALTH PLAN. A comprehensive plan which is prepared triennially and reviewed at least annually and revised as necessary by the Statewide Health Coordinating Council, with the assistance of the State Health Planning and Development Agency, and approved by the Governor.

The Statewide Health Coordinating Council shall meet at least annually to determine whether revisions for the State Health Plan are necessary. If the Statewide Health Coordinating Council fails to meet and to review or revise the State Health Plan on an annual basis, there shall be no fees required on all certificate of need applications filed with the Certificate of Need Review Board until the Statewide Health Coordinating Council meets and reviews or revises the State Health Plan. For purposes of this paragraph, the annual meeting of the Statewide Health Coordinating Council shall occur on or before August 1 of each calendar year.

The State Health Plan shall provide for the development of health programs and resources to assure that quality health services will be available and accessible in a manner which assures continuity of care, at reasonable costs, for all residents of the state. Nothing in this section should be construed as permitting expenditures for facilities, services, or equipment which are inconsistent with the State Health Plan.

(14) STATE HEALTH PLANNING AND DEVELOPMENT AGENCY (SHPDA). An agency of the State of Alabama which is designated by the Governor as the sole State Health Planning and Development Agency, which shall consist of three consumers, three providers, and three representatives of the Governor who all shall serve staggered terms and all be appointed by the Governor. Where used in this article, the terms, “state agency,” and the “SHPDA,” shall be synonymous and may be used interchangeably.

(15) STATEWIDE HEALTH COORDINATING COUNCIL. A council, appointed by the Governor, established pursuant to Sections 22-4-7 and 22-4-8 to advise the State Health Planning and Development Agency on matters relating to health planning and resource development and to perform other functions as may be delegated to it, to include an annual review of the State Health Plan.

(16) TO OFFER. When used in connection with health services, a health care facility or health maintenance organization that holds itself out as capable of providing, or as having the means for the provision of, specified health services.

(Acts 1977, 1st Ex. Sess., No. 82, p. 1509, §2; Acts 1979, No. 79-577, p. 1033, §1; Acts 1982, 2nd Ex. Sess., No. 82-770, p. 249, §1; Acts 1984, No. 84-281, p. 468; Acts 1990, No. 90-468, §1; Acts 1993, No. 93-93, p. 147, §2; Acts 1994, No. 94-369, p. 620, §1; Act 2003-331, p. 810, §1; Act 2009-492, p. 906, §1; Act 2013-192, p. 350, §1.)

Notes of Decisions

Cited in 36 cases, 1987–2017 · leading case: Prime Lithotripter Oper. v. Lithomedtech of Alabama, LLC, 855 So. 2d 1085 (Ala. Civ. App. 2001).

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Prime Lithotripter Oper. v. Lithomedtech of Alabama, LLC, 855 So. 2d 1085 (Ala. Civ. App. 2001). · cites it 11× “In the complaint, UroVenture sought a declaration that it was not required to seek CON review under § 22-21-260, et seq., Ala.Code 1975, absent implication of the criteria set forth in § 22-21-263; it also sought a declaration that CON Rule 410-1-4-.”

Pleasure Island Ambulatory Surgery Ctr., LLC v. State Health Plan. & Dev. Agency, 38 So. 3d 739 (Ala. Civ. App. 2008). · cites it 11× “Further, our holding is consistent with the purpose underlying the statutes governing CON review, § 22-21-260 et seq., Ala.Code 1975. Section 22-21-261, Ala.”

Infirmary Health Sys. v. Sacred Heart Health Sys., Inc., 155 So. 3d 980 (Ala. 2012). · cites it 13× “2 Section 22-21-260 et seq., Ala. Code 1975, sets out the law concerning the regulation of health-care facilities.”

Daniel Senior Living of Inverness I, LLC v. STV One Nineteen Senior Living, LLC, 161 So. 3d 196 (Ala. 2014). · cites it 8× “” To effectuate the aforesaid purpose, the legislature enacted Article 9, “Control and Regulation of Development of Certain Health Care Facilities,” of Title 22, Chapter 21, of the Alabama Code, codified at §§ 22-21-260 to 22-21-278, Ala.Code 1975.”

Opinion of the Justices, 599 So. 2d 1166 (Ala. 1992). · cites it 13× “Specifically, you requested that this Court resolve the apparent conflict between Alabama Code 1975, § 22-21-260, providing that the term “health care facility” does not include veterans’ nursing homes operated by the Department of Veterans’ Affairs (so that nursing homes…”

Sacred Heart Health Sys., Inc. v. Infirmary Health Sys., 155 So. 3d 989 (Ala. Civ. App. 2013). · cites it 18× “; and § 22-21-276(a), one of the statutes relating to the regulation of health-care facilities, codified at Ala. Code 1975, § 22-21-260 et seq. The opponents specifically requested that the circuit court determine that a CON was required for Sacred Heart to offer health-care…”

HealthSouth of Alabama, LLC v. Shelby Ridge Acquisition Corp., 207 So. 3d 14 (Ala. Civ. App. 2015). · cites it 7× “To accomplish this purpose, the legislature has enacted comprehensive regulatory statutes in Title 22, Chapter 21, Article 9, § 22-21-260 et seq., Ala.Code 1975. Any entity or individual planning to furnish a “new insti *18 tutional health service” in this state must first…”

Ex Parte Traylor Nursing Home, Inc., 543 So. 2d 1179 (Ala. 1988). · cites it 3× “" § 22-21-260(2). The state agency is primarily responsible for presenting "by rules and regulations the criteria and clarifying definitions for reviews covered by this article.”

HEALTH CARE AUTH. OF ATHENS v. Statewide Health Coordinating Council, 988 So. 2d 574 (Ala. Civ. App. 2008). · cites it 2× “" § 22-21-260(13), Ala. Code 1975. The State Health Plan is a part of the Alabama Administrative Code.”

Daniel Senior Living of Inverness I, LLC v. STV One Nineteen Senior Living, LLC, 161 So. 3d 187 (Ala. Civ. App. 2012). · cites it 3× “” § 22-21-260(13), Ala. Code 1975. The Council prepares, reviews, revises, and approves the State Health Plan.”

Auburn Med. Ctr., Inc. v. Andrus, 9 F. Supp. 2d 1291 (M.D. Ala. 1998). · cites it 2× “) Defendants argue that these actions do not constitute mail fraud, as Defendants were merely exercising their rights under Alabama statutory law and administrative regulations to file a CON application on behalf of EAMC.”

Sacred Heart Health Sys., Inc. v. Infirmary Health Sys., 155 So. 3d 969 (Ala. Civ. App. 2010). · cites it 15× “; and § 22-21-276(a), one of the statutes relating to the regulation of health-care facilities, codified at Ala.Code 1975, § 22-21-260 et seq. The opponents specifically requested that the circuit court determine that a CON was required for Sacred Heart to offer health-care…”

Show all 36 citing cases →

— Ala. Code § 22-21-260(1) — 2 cases

Affinity Hosp., LLC v. Brookwood Health Servs. Inc., 143 So. 3d 208 (Ala. Civ. App. 2013).

Noland Hosp. Shelby, LLC v. Select Specialty Hospitals, Inc., 193 So. 3d 751 (Ala. Civ. App. 2015).

— Ala. Code § 22-21-260(13) — 15 cases

Daniel Senior Living of Inverness I, LLC v. STV One Nineteen Senior Living, LLC, 161 So. 3d 196 (Ala. 2014). “” To effectuate the aforesaid purpose, the legislature enacted Article 9, “Control and Regulation of Development of Certain Health Care Facilities,” of Title 22, Chapter 21, of the Alabama Code, codified at §§ 22-21-260 to 22-21-278, Ala.Code 1975.”

HealthSouth of Alabama, LLC v. Shelby Ridge Acquisition Corp., 207 So. 3d 14 (Ala. Civ. App. 2015). “To accomplish this purpose, the legislature has enacted comprehensive regulatory statutes in Title 22, Chapter 21, Article 9, § 22-21-260 et seq., Ala.Code 1975. Any entity or individual planning to furnish a “new insti *18 tutional health service” in this state must first…”

Colbert Cnty. Nw. Alabama Health Care Auth. v. RegionalCare Hosp. Partners, Inc., 195 So. 3d 948 (Ala. Civ. App. 2015).

HEALTH CARE AUTH. OF ATHENS v. Statewide Health Coordinating Council, 988 So. 2d 574 (Ala. Civ. App. 2008). “" § 22-21-260(13), Ala. Code 1975. The State Health Plan is a part of the Alabama Administrative Code.”

Affinity Hosp., LLC v. St. Vincent's Health Sys., 129 So. 3d 1022 (Ala. Civ. App. 2012).

— Ala. Code § 22-21-260(14) — 5 cases

Huntsville Hous. Auth. v. State Licensing Bd. for Gen. Contractors, 179 So. 3d 146 (Ala. Civ. App. 2014).

Foley Hosp. Corp. v. Gulf Health Hospitals, Inc., 157 So. 3d 925 (Ala. Civ. App. 2014).

Ex parte STV One Nineteen Senior Living, LLC, d/b/a Somerby at St. Vincent's One Nineteen. (Ala. 2014).

— Ala. Code § 22-21-260(2) — 3 cases

Ex Parte Traylor Nursing Home, Inc., 543 So. 2d 1179 (Ala. 1988). “" § 22-21-260(2). The state agency is primarily responsible for presenting "by rules and regulations the criteria and clarifying definitions for reviews covered by this article.”

Montgomery Rehab. Hosp., Inc. v. State Health Plan. Agency, 610 So. 2d 403 (Ala. Civ. App. 1992).

Montgomery Rehab. Hosp. v. HEALTH Plan., 610 So. 2d 403 (Ala. Civ. App. 1992).

— Ala. Code § 22-21-260(3) — 2 cases

Daniel Senior Living of Inverness I, LLC v. STV One Nineteen Senior Living, LLC, 161 So. 3d 187 (Ala. Civ. App. 2012). “” § 22-21-260(13), Ala. Code 1975. The Council prepares, reviews, revises, and approves the State Health Plan.”

Springhill Hosps., Inc. v. State Health Plan. & Dev. Agency, 253 So. 3d 955 (Ala. Civ. App. 2017).

— Ala. Code § 22-21-260(4) — 5 cases

Pleasure Island Ambulatory Surgery Ctr., LLC v. State Health Plan. & Dev. Agency, 38 So. 3d 739 (Ala. Civ. App. 2008). “Further, our holding is consistent with the purpose underlying the statutes governing CON review, § 22-21-260 et seq., Ala.Code 1975. Section 22-21-261, Ala.”

Traylor Nursing Home, Inc. v. Alabama Statewide Health Coordinating Council, 543 So. 2d 1176 (Ala. Civ. App. 1987).

— Ala. Code § 22-21-260(5) — 1 case

Opinion of the Justices, 599 So. 2d 1166 (Ala. 1992). “Specifically, you requested that this Court resolve the apparent conflict between Alabama Code 1975, § 22-21-260, providing that the term “health care facility” does not include veterans’ nursing homes operated by the Department of Veterans’ Affairs (so that nursing homes…”

— Ala. Code § 22-21-260(6) — 5 cases

Sacred Heart Health Sys., Inc. v. Infirmary Health Sys., 155 So. 3d 989 (Ala. Civ. App. 2013). “; and § 22-21-276(a), one of the statutes relating to the regulation of health-care facilities, codified at Ala. Code 1975, § 22-21-260 et seq. The opponents specifically requested that the circuit court determine that a CON was required for Sacred Heart to offer health-care…”

Infirmary Health Sys. v. Sacred Heart Health Sys., Inc., 155 So. 3d 980 (Ala. 2012). “2 Section 22-21-260 et seq., Ala. Code 1975, sets out the law concerning the regulation of health-care facilities.”

Sacred Heart Health Sys., Inc. v. Infirmary Health Sys., 155 So. 3d 969 (Ala. Civ. App. 2010). “; and § 22-21-276(a), one of the statutes relating to the regulation of health-care facilities, codified at Ala.Code 1975, § 22-21-260 et seq. The opponents specifically requested that the circuit court determine that a CON was required for Sacred Heart to offer health-care…”

Sacred Heart Health Sys., Inc. v. Infirmary Health Sys., Inc., 155 So. 3d 1002 (Ala. 2014).

— Ala. Code § 22-21-260(7) — 2 cases

Shelby Cnty. Treatment Ctr. v. Edmondson, 945 So. 2d 1048 (Ala. Civ. App. 2005).

— Ala. Code § 22-21-260(8) — 4 cases

Prime Lithotripter Oper. v. Lithomedtech of Alabama, LLC, 855 So. 2d 1085 (Ala. Civ. App. 2001). “In the complaint, UroVenture sought a declaration that it was not required to seek CON review under § 22-21-260, et seq., Ala.Code 1975, absent implication of the criteria set forth in § 22-21-263; it also sought a declaration that CON Rule 410-1-4-.”

Todoroy v. DCH Healthcare Auth., 921 F.2d 1438 (11th Cir. 1991).

— Ala. Code § 22-21-260(9) — 2 cases

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