Iowa Code » Chapter 135 — DEPARTMENT OF HEALTH AND HUMAN SERVICES — PUBLIC HEALTH
Iowa Code

Iowa Code § 135.64 (2026)

Letter of intent to precede application — review and comment

✓ current as of July 2026
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1. Before applying for a certificate of need, the sponsor of a proposed new institutional health service or changed institutional health service shall submit to the department a letter of intent to offer or develop a service requiring a certificate of need. The letter shall be submitted as soon as possible after initiation of the applicant’s planning process, and in any case not less than thirty days before applying for a certificate of need and before substantial expenditures to offer or develop the service are made. The letter shall include a brief description of the proposed new or changed service, its location, and its estimated cost. 2. Upon request of the sponsor of the proposed new or changed service, the department shall make a preliminary review of the letter for the purpose of informing the sponsor of the project of any factors which may appear likely to result in denial of a certificate of need, based on the criteria for evaluation of applications in section 135.63. A comment by the department under this section shall not constitute a final decision. [C79, 81, §135.65] 91 Acts, ch 225, §6; 97 Acts, ch 93, §9; 2023 Acts, ch 19, §1443 C2024, §10A.715 2025 Acts, ch 120, §40, 54 C2026, §135.64 Referred to in §135.66 Section transferred from §10A.715 in Code 2026 pursuant to directive in 2025 Acts, ch 120, §40 Subsection 2 amended

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Notes of Decisions
Cited in 10 cases, 1980–2020 · leading case: Greenwood Manor v. Iowa Dep't of Pub. Health, State Health Facilities Council, 641 N.W.2d 823 (Iowa 2002).
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Greenwood Manor v. Iowa Dep't of Pub. Health, State Health Facilities Council, 641 N.W.2d 823 (Iowa 2002). · cites it 17× “See Iowa Code § 135.64 (1); Iowa Admin. Code r.”
Mercy Health Ctr., a Div. of Sisters of Mercy Health Corp. v. State Health Facilities Council, 360 N.W.2d 808 (Iowa 1985). · cites it 8× “Mercy supports the holding on the ground it is not specifically mentioned among the criteria in section 135.64 and by pointing to the absence of any specific administrative rule on cross-subsidies.”
Lee Birchansky v. Gerd Clabaugh, 955 F.3d 751 (8th Cir. 2020). “61 (18)(c); Iowa 2 The Iowa Health Facilities Council evaluates CON applications according to criteria set forth at Iowa Code § 135.64 . These criteria include the needs of the population the proposed facility will serve and its impact on existing facilities.”
Birchansky Real Est., L.c., & Fox Eye Surgery, L.l.c. Vs. Iowa Dep't Of Pub. Health, State Health Facilities Council, 737 N.W.2d 134 (Iowa 2007). · cites it 4× “Iowa Code § 135.64 (2). The Department found none of these four criteria existed in *141 the Cedar Rapids area.”
On With Life, Inc. v. State Health Facilities Council, 532 N.W.2d 496 (Iowa Ct. App. 1995). · cites it 8× “See Iowa Code § 135.64 (l)(c) (council shall consider “the need of the population served or to be served by the proposed” expansion).”
Northbrook Residents Ass'n v. Iowa State Dep't of Health Off. for Health Plan. & Dev., 298 N.W.2d 330 (Iowa 1980). · cites it 2× “Such written findings are required by section 135.64(2, a-d). Thereafter the health facilities council issued a written decision in which the certificate of need was reissued to Discovery Village.”
UnityPoint Health Cedar Rapids d/b/a St. Luke's Hosp. v. Iowa Dep't of Pub. Health, State Health Facilities Council & Mercy Hosp. Cedar Rapids d/b/a Mercy Med. Ctr. (Iowa Ct. App. 2019). · cites it 22× “69 (providing the Council shall make the final decision on a CON application); 135.62(2)(f)(1)–(5) (enumerating the duties of the Council).”
Birchansky Real Est. v. Dep't, 737 N.W.2d 134 (Iowa 2007). · cites it 4× “Iowa Code § 135.64 (2). The Department found none of these four criteria existed in *141 the Cedar Rapids area.”
Surgery Ctr. of Cedar Rapids v. Iowa Dep't of Pub. Health (Iowa Ct. App. 2020). · cites it 6× “See Iowa Code § 135.64 (setting forth criteria for evaluation of CON applications).”
Mercy Hosp., Cedar Rapids, Iowa D/B/A Mercy Med. Ctr. v. Iowa Dep't of Pub. Health, State Health Facilities Council, & St. Luke's Hosp., Intervenor-Appellee. (Iowa Ct. App. 2016). · cites it 2× “Luke’s similar application for a CON and was made without adequate justification for the contrary result. See Iowa Code § 17A.19(10)(h) (2013).”
— Iowa Code § 135.64(1) — 4 cases
Greenwood Manor v. Iowa Dep't of Pub. Health, State Health Facilities Council, 641 N.W.2d 823 (Iowa 2002). “See Iowa Code § 135.64 (1); Iowa Admin. Code r.”
Birchansky Real Est., L.c., & Fox Eye Surgery, L.l.c. Vs. Iowa Dep't Of Pub. Health, State Health Facilities Council, 737 N.W.2d 134 (Iowa 2007). “Iowa Code § 135.64 (2). The Department found none of these four criteria existed in *141 the Cedar Rapids area.”
Birchansky Real Est. v. Dep't, 737 N.W.2d 134 (Iowa 2007). “Iowa Code § 135.64 (2). The Department found none of these four criteria existed in *141 the Cedar Rapids area.”
Surgery Ctr. of Cedar Rapids v. Iowa Dep't of Pub. Health (Iowa Ct. App. 2020). “See Iowa Code § 135.64 (setting forth criteria for evaluation of CON applications).”
— Iowa Code § 135.64(2) — 3 cases
Greenwood Manor v. Iowa Dep't of Pub. Health, State Health Facilities Council, 641 N.W.2d 823 (Iowa 2002). “See Iowa Code § 135.64 (1); Iowa Admin. Code r.”
On With Life, Inc. v. State Health Facilities Council, 532 N.W.2d 496 (Iowa Ct. App. 1995). “See Iowa Code § 135.64 (l)(c) (council shall consider “the need of the population served or to be served by the proposed” expansion).”
UnityPoint Health Cedar Rapids d/b/a St. Luke's Hosp. v. Iowa Dep't of Pub. Health, State Health Facilities Council & Mercy Hosp. Cedar Rapids d/b/a Mercy Med. Ctr. (Iowa Ct. App. 2019). “69 (providing the Council shall make the final decision on a CON application); 135.62(2)(f)(1)–(5) (enumerating the duties of the Council).”
— Iowa Code § 135.64(2)(a) — 3 cases
Mercy Health Ctr., a Div. of Sisters of Mercy Health Corp. v. State Health Facilities Council, 360 N.W.2d 808 (Iowa 1985). “Mercy supports the holding on the ground it is not specifically mentioned among the criteria in section 135.64 and by pointing to the absence of any specific administrative rule on cross-subsidies.”
UnityPoint Health Cedar Rapids d/b/a St. Luke's Hosp. v. Iowa Dep't of Pub. Health, State Health Facilities Council & Mercy Hosp. Cedar Rapids d/b/a Mercy Med. Ctr. (Iowa Ct. App. 2019). “69 (providing the Council shall make the final decision on a CON application); 135.62(2)(f)(1)–(5) (enumerating the duties of the Council).”
Mercy Hosp., Cedar Rapids, Iowa D/B/A Mercy Med. Ctr. v. Iowa Dep't of Pub. Health, State Health Facilities Council, & St. Luke's Hosp., Intervenor-Appellee. (Iowa Ct. App. 2016). “Luke’s similar application for a CON and was made without adequate justification for the contrary result. See Iowa Code § 17A.19(10)(h) (2013).”
— Iowa Code § 135.64(2)(b) — 1 case
UnityPoint Health Cedar Rapids d/b/a St. Luke's Hosp. v. Iowa Dep't of Pub. Health, State Health Facilities Council & Mercy Hosp. Cedar Rapids d/b/a Mercy Med. Ctr. (Iowa Ct. App. 2019). “69 (providing the Council shall make the final decision on a CON application); 135.62(2)(f)(1)–(5) (enumerating the duties of the Council).”
— Iowa Code § 135.64(2)(d) — 1 case
UnityPoint Health Cedar Rapids d/b/a St. Luke's Hosp. v. Iowa Dep't of Pub. Health, State Health Facilities Council & Mercy Hosp. Cedar Rapids d/b/a Mercy Med. Ctr. (Iowa Ct. App. 2019). “69 (providing the Council shall make the final decision on a CON application); 135.62(2)(f)(1)–(5) (enumerating the duties of the Council).”
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