N.C. Gen. Stat. » Chapter 131E
NC General Statutes

N.C. Gen. Stat. § 131E-181 (2026)

Nature of certificate of need

✓ current as of July 2026
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(a) A certificate of need shall be valid only for the defined scope, physical location, and person named in the application. A certificate of need shall not be transferred or assigned except as provided in G.S. 131E-189(c).

(b) A recipient of a certificate of need, or any person who may subsequently acquire, in any manner whatsoever permitted by law, the service for which that certificate of need was issued, is required to materially comply with the representations made in its application for that certificate of need. The Department shall require any recipient of a certificate of need, or its successor, whose service is in operation to submit to the Department evidence that the recipient, or its successor, is in material compliance with the representations made in its application for the certificate of need which granted the recipient the right to operate that service. In determining whether the recipient of a certificate of need, or its successor, is operating a service which materially differs from the representations made in its application for that certificate of need, the Department shall consider cost increases to the recipient, or its successor, including, but not limited to, the following:

(1) Any increase in the consumer price index;

(2) Any increased cost incurred because of Government requirements, including federal, State, or any political subdivision thereof; and

(3) Any increase in cost due to professional fees or the purchase of services and supplies.

(c) Whenever a certificate of need is issued more than 12 months after the application for the certificate of need began review, the Department shall adjust the capital expenditure amount proposed by increasing it to reflect any inflation in the Department of Commerce's Construction Cost Index that has occurred since the date when the application began review; and the Department shall use this recalculated capital expenditure amount in the certificate of need issued for the project.

(d) A project authorized by a certificate of need is complete when the health service or the health service facility for which the certificate of need was issued is licensed and certified and is in material compliance with the representations made in the certificate of need application.  (1977, 2nd Sess., c. 1182, s. 2; 1981, c. 651, s. 5; 1983, c. 775, s. 1; 1985, c. 521, s. 1; 1985 (Reg. Sess., 1986), c. 968, s. 1; 1987, c. 511, s. 1; 1989, c. 233, c. 751, s. 9(c); 1991, c. 692, s. 5; 1991 (Reg. Sess., 1992), c. 959, s. 85; 1993, c. 7, s. 5.)

 

Notes of Decisions
Cited in 12 cases (4 in the last 5 years), 1995–2025 · leading case: Good Hope Health Sys., L.L.C. v. N.C. Dep't of Health & Human Servs., 659 S.E.2d 456 (N.C. Ct. App. 2008).
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Good Hope Health Sys., L.L.C. v. N.C. Dep't of Health & Human Servs., 659 S.E.2d 456 (N.C. Ct. App. 2008). · cites it 42× “N.C. Gen.Stat. § 131E-181 N.C. Gen.Stat. § 131E-181 (2003) states, "[a] certificate of need shall be valid only for the defined scope, physical location, and person named in the application.”
Cumberland Cnty. Hosp. Sys., Inc. v. N.C. Dep't of Health & Human Servs., 776 S.E.2d 329 (N.C. Ct. App. 2015). · cites it 14× “CON Scope Petitioners also contend that DHHS's No Review Decision violated N.C. Gen.Stat. § 131E-181(a), which provides that "[a] certificate of need *536 shall be valid only for the defined scope, physical location, and person named in the application.”
Craven Reg'l Med. Auth. v. N.C. Dep't of Health & Human Servs., 625 S.E.2d 837 (N.C. Ct. App. 2006). · cites it 2× “N.C. Gen. Stat. § 131E-181(a)(5) (2005). We disagree.”
Good Hope Hosp., Inc. v. North Carolina Dep't of Health & Human Servs., 623 S.E.2d 315 (N.C. Ct. App. 2006). · cites it 2× “§ 131E-175(1)-(7) and § 131E-181(a)(4)). Good Hope was not destroyed or damaged by accident or natural disaster.”
Hospice at Greensboro, Inc. v. North Carolina Dep't of Health & Human Servs. of Facility Servs., 647 S.E.2d 651 (N.C. Ct. App. 2007). · cites it 2× “” See N.C. Gen. Stat. § 131E-181(a) (entitled “Nature of a Certificate of Need”) (stating “[a] certificate of need shall be valid only for the defined scope, physical location, and person named in the application).”
Total Renal Care of North Carolina LLC v. North Carolina Dep't of Health, 673 S.E.2d 137 (N.C. Ct. App. 2009). · cites it 2× “” N.C. Gen. Stat. § 131E-181(d). Kidney disease *382 treatment centers, the subject of the CON in this case, are not “licensed” by the State, but rather are “certified” by the federal government.”
Duke Univ. Health Sys. Inc. v. N.C. Dep't of Health & Hum. Servs. (N.C. Ct. App. 2024). · cites it 22× “] § 131E-181; Hale, Vol. 2, p. 248; Meyer, Vol.”
FMSH LLC v. NC Dep't of Health & Hum. Servs. (N.C. Ct. App. 2021). · cites it 4× “” N.C. Gen. Stat. § 131E-181(b) (2019). ¶ 14 A CON may be transferred or reassigned by an active health service provider, but only if the transfer or reassignment complies with the terms of N.”
FMSH LLC v. NC Dep't of Health & Hum. Servs. (N.C. Ct. App. 2021). · cites it 4× “” N.C. Gen. Stat. § 131E-181(b) (2019). ¶ 14 A CON may be transferred or reassigned by an active health service provider, but only if the transfer or reassignment complies with the terms of N.”
Johnston Health Care Ctr., L.L.C. v. North Carolina Dep't of Human Resources, 524 S.E.2d 352 (N.C. Ct. App. 2000). “, President of Liberty, which included a sworn statement that: ‘The applicant will materially comply with the representations made in its application in its development of the project and the offering of the service pursuant to G.S. 131E-181(b);’ and ‘The information included in…”
MH Mission Hosp., LLLP v. N.C. Dep't of Health & Hum. Servs. (N.C. Ct. App. 2025). · cites it 2× “Opinion of the Court the proposed project is cost-effective and would not incur unreasonable costs in developing its proposed project and to include reasonable and adequate information to demonstrate the project can be developed at its proposed site. Mission Memorial argues the…”
Laurel Wood of Henderson, Inc. v. North Carolina Dep't of Human Resources, 452 S.E.2d 334 (N.C. Ct. App. 1995). “The letter cautioned: Please be aware that pursuant to G.S. 131E-181(b), you are required to materially comply with the representations made in your application for a Certificate of Need.”
— N.C. Gen. Stat. § 131E-181(a) — 6 cases
Good Hope Health Sys., L.L.C. v. N.C. Dep't of Health & Human Servs., 659 S.E.2d 456 (N.C. Ct. App. 2008). “N.C. Gen.Stat. § 131E-181 N.C. Gen.Stat. § 131E-181 (2003) states, "[a] certificate of need shall be valid only for the defined scope, physical location, and person named in the application.”
Cumberland Cnty. Hosp. Sys., Inc. v. N.C. Dep't of Health & Human Servs., 776 S.E.2d 329 (N.C. Ct. App. 2015). “CON Scope Petitioners also contend that DHHS's No Review Decision violated N.C. Gen.Stat. § 131E-181(a), which provides that "[a] certificate of need *536 shall be valid only for the defined scope, physical location, and person named in the application.”
Hospice at Greensboro, Inc. v. North Carolina Dep't of Health & Human Servs. of Facility Servs., 647 S.E.2d 651 (N.C. Ct. App. 2007). “” See N.C. Gen. Stat. § 131E-181(a) (entitled “Nature of a Certificate of Need”) (stating “[a] certificate of need shall be valid only for the defined scope, physical location, and person named in the application).”
Duke Univ. Health Sys. Inc. v. N.C. Dep't of Health & Hum. Servs. (N.C. Ct. App. 2024). “] § 131E-181; Hale, Vol. 2, p. 248; Meyer, Vol.”
FMSH LLC v. NC Dep't of Health & Hum. Servs. (N.C. Ct. App. 2021). “” N.C. Gen. Stat. § 131E-181(b) (2019). ¶ 14 A CON may be transferred or reassigned by an active health service provider, but only if the transfer or reassignment complies with the terms of N.”
— N.C. Gen. Stat. § 131E-181(a)(4) — 1 case
Good Hope Hosp., Inc. v. North Carolina Dep't of Health & Human Servs., 623 S.E.2d 315 (N.C. Ct. App. 2006). “§ 131E-175(1)-(7) and § 131E-181(a)(4)). Good Hope was not destroyed or damaged by accident or natural disaster.”
— N.C. Gen. Stat. § 131E-181(a)(5) — 1 case
Craven Reg'l Med. Auth. v. N.C. Dep't of Health & Human Servs., 625 S.E.2d 837 (N.C. Ct. App. 2006). “N.C. Gen. Stat. § 131E-181(a)(5) (2005). We disagree.”
— N.C. Gen. Stat. § 131E-181(b) — 7 cases
Cumberland Cnty. Hosp. Sys., Inc. v. N.C. Dep't of Health & Human Servs., 776 S.E.2d 329 (N.C. Ct. App. 2015). “CON Scope Petitioners also contend that DHHS's No Review Decision violated N.C. Gen.Stat. § 131E-181(a), which provides that "[a] certificate of need *536 shall be valid only for the defined scope, physical location, and person named in the application.”
Duke Univ. Health Sys. Inc. v. N.C. Dep't of Health & Hum. Servs. (N.C. Ct. App. 2024). “] § 131E-181; Hale, Vol. 2, p. 248; Meyer, Vol.”
Johnston Health Care Ctr., L.L.C. v. North Carolina Dep't of Human Resources, 524 S.E.2d 352 (N.C. Ct. App. 2000). “, President of Liberty, which included a sworn statement that: ‘The applicant will materially comply with the representations made in its application in its development of the project and the offering of the service pursuant to G.S. 131E-181(b);’ and ‘The information included in…”
FMSH LLC v. NC Dep't of Health & Hum. Servs. (N.C. Ct. App. 2021). “” N.C. Gen. Stat. § 131E-181(b) (2019). ¶ 14 A CON may be transferred or reassigned by an active health service provider, but only if the transfer or reassignment complies with the terms of N.”
FMSH LLC v. NC Dep't of Health & Hum. Servs. (N.C. Ct. App. 2021). “” N.C. Gen. Stat. § 131E-181(b) (2019). ¶ 14 A CON may be transferred or reassigned by an active health service provider, but only if the transfer or reassignment complies with the terms of N.”
— N.C. Gen. Stat. § 131E-181(d) — 1 case
Total Renal Care of North Carolina LLC v. North Carolina Dep't of Health, 673 S.E.2d 137 (N.C. Ct. App. 2009). “” N.C. Gen. Stat. § 131E-181(d). Kidney disease *382 treatment centers, the subject of the CON in this case, are not “licensed” by the State, but rather are “certified” by the federal government.”
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