Code of Alabama
Ala. Code § 22-21-266 (2026)
Certificates of Need - Required Findings for Inpatient Facilities.
✓ official Alabama Legislature (ALISON) text, current July 2026
No certificate of need for new inpatient facilities or services shall be issued unless the SHPDA makes each of the following findings:
(1) That the proposed facility or service is consistent with the latest approved revision of the appropriate state plan effective at the time the application was received by the state agency;
(2) That less costly, more efficient or more appropriate alternatives to such inpatient service are not available, and that the development of such alternatives has been studied and found not practicable;
(3) That existing inpatient facilities providing inpatient services similar to those proposed are being used in an appropriate and efficient manner consistent with community demands for services;
(4) That in the case of new construction, alternatives to new construction (e.g., modernization and sharing arrangement) have been considered and have been implemented to the maximum extent practicable; and
(5) That patients will experience serious problems in obtaining inpatient care of the type proposed in the absence of the proposed new service.
(Acts 1977, 1st Ex. Sess., No. 82, p. 1509, §7; Acts 1982, 2nd Ex. Sess., No. 82-770, p. 249, §6.)
Notes of Decisions
Cited in 15
cases, 1985–2016 · leading case: Ex Parte Shelby Med. Ctr., Inc., 564 So. 2d 63 (Ala. 1990).
Ex Parte Shelby Med. Ctr., Inc., 564 So. 2d 63 (Ala. 1990). “Sufficiency of the evidence The Court of Civil Appeals ruled that substantial evidence supported each of the findings required by Alabama Code 1975, § 22-21-266. Under § 22-21-266, SHPDA must make each of the following findings before granting a CON for new inpatient facilities…”
Affinity Hosp., LLC v. St. Vincent's Health Sys., 129 So. 3d 1022 (Ala. Civ. App. 2012). “The supreme court concluded, among other things, that there was insufficient evidence to establish each of the five requirements for new inpatient facilities or services found in § 22 — 21—266(1)—(5).”
State Health Plan. v. Rivendell of Ala., 469 So. 2d 613 (Ala. Civ. App. 1985). “" Section 22-21-266, Code of Alabama 1975, states that the SHPDA board cannot issue a CON unless it makes all of the following five findings: "(1) That the proposed facility or service is consistent with the latest approved revision of the appropriate state plan effective at the…”
Alacare Home Health Servs., Inc. v. Alabama State Health Plan. & Dev. Agency, 27 So. 3d 1267 (Ala. Civ. App. 2009). “” If SHPDA is unable to make any of the five findings required by § 22-21-266, then a CON “cannot be issued.”
Montgomery Rehab. Hosp., Inc. v. State Health Plan. Agency, 610 So. 2d 403 (Ala. Civ. App. 1992). “See § 22-21-266, Ala.Code 1975. In April 1990 Southeast’s CON application was considered by SHPA’s CON Review Board (Board) at a public hearing, where Montgomery Rehabilitation Hospital, Inc.”
Affinity Hosp., LLC v. Brookwood Health Servs. Inc., 143 So. 3d 208 (Ala. Civ. App. 2013). “, Ala.Code 1975, § 22-21-266(1) (prohibiting the issuance of a CON unless a proposed facility or service is “consistent with” the SHP), and § 22-21-263(a) (stating that no institutional health services “which are inconsistent with the [SHP]” are permitted), is meaningful and…”
HealthSouth of Alabama, LLC v. Shelby Ridge Acquisition Corp., 207 So. 3d 39 (Ala. 2016). “Neither of the considerations prioritized by the Court of Civil Appeals is a required finding under § 22-21-266, which provides: “No certificate of need for new inpatient facilities or services shall be issued unless the SHPDA makes each of the following findings: “(1) That the…”
HealthSouth of Alabama, LLC v. Shelby Ridge Acquisition Corp., 207 So. 3d 14 (Ala. Civ. App. 2015). “We note that the CONRB, as well as the ALJ, determined that Shelby Ridge’s CON application did not meet the CONRB’s criteria regarding consistency with the SHP, licensing for the project, consistency with Shelby Ridge’s long-range development plans, and complying with the…”
Forest Manor, Inc. v. SHPDA, 723 So. 2d 75 (Ala. Civ. App. 1998). “1975, Section 22-21-266, with respect to inpatient facilities or services, if applicable, as well as whether the application is consistent with each of the applicable criteria and standards set forth in Chapter 6 of these rules, and whether the application is consistent with the…”
Noland Hosp. Shelby, LLC v. Select Specialty Hospitals, Inc., 193 So. 3d 751 (Ala. Civ. App. 2015). “He outlined a myriad of reasons that Select’s CON application should not be approved, including, among other determinations, that Select had failed to meet each of the criteria outlined in Ala.Code 1975, § 22-21-266. The CONRB, after a brief hearing, rejected the ALJ’s…”
Brookwood Health Servs., Inc. v. Baptist Health Sys., Inc., 936 So. 2d 529 (Ala. Civ. App. 2005). “Code [1975,] § 22-21-266(3) ... requires a finding that ‘existing inpatient facilities providing inpatient services similar to those proposed are being used in an appropriate and efficient manner consistent with community demands for services,’ ie.”
Montgomery Rehab. Hosp. v. HEALTH Plan., 610 So. 2d 403 (Ala. Civ. App. 1992). “See § 22-21-266, Ala.Code 1975. In April 1990 Southeast's CON application was considered by SHPA's CON Review Board (Board) at a public hearing, where Montgomery Rehabilitation Hospital, Inc.”
— Ala. Code § 22-21-266(1) — 5 cases
Affinity Hosp., LLC v. St. Vincent's Health Sys., 129 So. 3d 1022 (Ala. Civ. App. 2012). “The supreme court concluded, among other things, that there was insufficient evidence to establish each of the five requirements for new inpatient facilities or services found in § 22 — 21—266(1)—(5).”
Affinity Hosp., LLC v. Brookwood Health Servs. Inc., 143 So. 3d 208 (Ala. Civ. App. 2013). “, Ala.Code 1975, § 22-21-266(1) (prohibiting the issuance of a CON unless a proposed facility or service is “consistent with” the SHP), and § 22-21-263(a) (stating that no institutional health services “which are inconsistent with the [SHP]” are permitted), is meaningful and…”
HealthSouth of Alabama, LLC v. Shelby Ridge Acquisition Corp., 207 So. 3d 14 (Ala. Civ. App. 2015). “We note that the CONRB, as well as the ALJ, determined that Shelby Ridge’s CON application did not meet the CONRB’s criteria regarding consistency with the SHP, licensing for the project, consistency with Shelby Ridge’s long-range development plans, and complying with the…”
Alacare Home Health Servs., Inc. v. Alabama State Health Plan. & Dev. Agency, 27 So. 3d 1267 (Ala. Civ. App. 2009). “” If SHPDA is unable to make any of the five findings required by § 22-21-266, then a CON “cannot be issued.”
Noland Hosp. Shelby, LLC v. Select Specialty Hospitals, Inc., 193 So. 3d 751 (Ala. Civ. App. 2015). “He outlined a myriad of reasons that Select’s CON application should not be approved, including, among other determinations, that Select had failed to meet each of the criteria outlined in Ala.Code 1975, § 22-21-266. The CONRB, after a brief hearing, rejected the ALJ’s…”
— Ala. Code § 22-21-266(2) — 3 cases
State Health Plan. v. Rivendell of Ala., 469 So. 2d 613 (Ala. Civ. App. 1985). “" Section 22-21-266, Code of Alabama 1975, states that the SHPDA board cannot issue a CON unless it makes all of the following five findings: "(1) That the proposed facility or service is consistent with the latest approved revision of the appropriate state plan effective at the…”
Alacare Home Health Servs., Inc. v. Alabama State Health Plan. & Dev. Agency, 27 So. 3d 1267 (Ala. Civ. App. 2009). “” If SHPDA is unable to make any of the five findings required by § 22-21-266, then a CON “cannot be issued.”
Noland Hosp. Shelby, LLC v. Select Specialty Hospitals, Inc., 193 So. 3d 751 (Ala. Civ. App. 2015). “He outlined a myriad of reasons that Select’s CON application should not be approved, including, among other determinations, that Select had failed to meet each of the criteria outlined in Ala.Code 1975, § 22-21-266. The CONRB, after a brief hearing, rejected the ALJ’s…”
— Ala. Code § 22-21-266(3) — 5 cases
Affinity Hosp., LLC v. St. Vincent's Health Sys., 129 So. 3d 1022 (Ala. Civ. App. 2012). “The supreme court concluded, among other things, that there was insufficient evidence to establish each of the five requirements for new inpatient facilities or services found in § 22 — 21—266(1)—(5).”
Brookwood Health Servs., Inc. v. Baptist Health Sys., Inc., 936 So. 2d 529 (Ala. Civ. App. 2005). “Code [1975,] § 22-21-266(3) ... requires a finding that ‘existing inpatient facilities providing inpatient services similar to those proposed are being used in an appropriate and efficient manner consistent with community demands for services,’ ie.”
Alacare Home Health Servs., Inc. v. Alabama State Health Plan. & Dev. Agency, 27 So. 3d 1267 (Ala. Civ. App. 2009). “” If SHPDA is unable to make any of the five findings required by § 22-21-266, then a CON “cannot be issued.”
Noland Hosp. Shelby, LLC v. Select Specialty Hospitals, Inc., 193 So. 3d 751 (Ala. Civ. App. 2015). “He outlined a myriad of reasons that Select’s CON application should not be approved, including, among other determinations, that Select had failed to meet each of the criteria outlined in Ala.Code 1975, § 22-21-266. The CONRB, after a brief hearing, rejected the ALJ’s…”
Brookwood Hlth. Serv. v. Baptist Hlth. Sys., 936 So. 2d 529 (Ala. Civ. App. 2005).
— Ala. Code § 22-21-266(5) — 3 cases
Affinity Hosp., LLC v. St. Vincent's Health Sys., 129 So. 3d 1022 (Ala. Civ. App. 2012). “The supreme court concluded, among other things, that there was insufficient evidence to establish each of the five requirements for new inpatient facilities or services found in § 22 — 21—266(1)—(5).”
Ex Parte Shelby Med. Ctr., Inc., 564 So. 2d 63 (Ala. 1990). “Sufficiency of the evidence The Court of Civil Appeals ruled that substantial evidence supported each of the findings required by Alabama Code 1975, § 22-21-266. Under § 22-21-266, SHPDA must make each of the following findings before granting a CON for new inpatient facilities…”
Noland Hosp. Shelby, LLC v. Select Specialty Hospitals, Inc., 193 So. 3d 751 (Ala. Civ. App. 2015). “He outlined a myriad of reasons that Select’s CON application should not be approved, including, among other determinations, that Select had failed to meet each of the criteria outlined in Ala.Code 1975, § 22-21-266. The CONRB, after a brief hearing, rejected the ALJ’s…”
— Ala. Code § 22-21-266(6) — 1 case
Noland Hosp. Shelby, LLC v. Select Specialty Hospitals, Inc., 193 So. 3d 751 (Ala. Civ. App. 2015). “He outlined a myriad of reasons that Select’s CON application should not be approved, including, among other determinations, that Select had failed to meet each of the criteria outlined in Ala.Code 1975, § 22-21-266. The CONRB, after a brief hearing, rejected the ALJ’s…”
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