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The Proposed 2024 SMFP Has Arrived - Petitions to Adjust Need Determinations Are Due Soon!
Wednesday, July 5, 2023

The North Carolina Department of Health and Human Services Division of Health Service Regulation (DHSR) has published the draft 2024 State Medical Facilities Plan (SMFP), which was developed by the State Health Coordinating Council (SHCC). The SMFP sets forth need determinations for many health care services, such as acute care beds, operating rooms and MRI scanners. While significant changes to North Carolina’s Certificate of Need laws are on the horizon, the SMFP remains a critical step in this process because, unless there is a published need determination for certain services, such as acute care beds, a Certificate of Need (CON) application cannot be filed to add the service. 

Interested parties can petition the SHCC to either add, reduce, or eliminate proposed need determinations in specific areas of North Carolina through a series of public hearings and summer petitions following the publication of the draft SMFP. All petitions for adjustments to need determinations in the Proposed 2024 SMFP are due by 5 pm on July 26, 2023. All comments on petitions are due by 5 pm on August 9, 2023. Public hearings are being held via WebEx from 1:30 pm- 2:30 pm eastern on the following dates:

  • July 10

  • July 12

  • July 18

  • July 20

  • July 25

  • July 26

Following the receipt of petitions and comments, DHSR staff will prepare recommendations, which are usually issued around Labor Day. In mid-September, each of the three SHCC committees (Acute Care Services, Long-Term and Behavioral Health, and Technology and Equipment) will meet to vote on petitions. The full SHCC will meet on October 4, 2023 to vote on the Proposed 2024 SMFP, including any petitions. After that, the draft SMFP will go to Governor Cooper for review and signature. The Governor has final authority over the SMFP, and he may accept the draft SMFP as is or amend it. The Governor is expected to sign the SMFP before December 31, 2023, and the 2024 SMFP will take effect on January 1, 2024.

Here are some of the highlights from the Proposed 2024 SMFP:

Acute Care Beds
Similar to this year, 2024 is shaping up to be another banner year for acute care bed need determinations, with significant need determinations both in densely populated urban counties and in several predominantly rural counties. The draft need determinations for acute care beds are:

  • Anson: 9

  • Buncombe/Graham/Madison/Yancey: 26

  • Cabarrus: 31

  • Durham/Caswell/Warren: 38

  • Mecklenburg: 90

  • Orange: 26

  • Union: 46

  • Wake: 70

Operating Rooms

The draft 2024 SMFP contains a need determination for operating rooms in only one county:

  • Wake: 5


Fixed Cardiac Catheterization Equipment:

Each of the following counties is shown to have a need for one additional unit of fixed cardiac catheterization equipment:

  • Cabarrus

  • Caldwell

There are no need determinations anywhere in North Carolina for shared fixed cardiac catheterization equipment.

Linear Accelerators:

The draft 2024 SMFP shows a need for one additional linear accelerator in Service Area 19, which includes Brunswick, Columbus, New Hanover, and Pender counties.


The draft 2024 SMFP shows a need determination for two additional mobile lithotripters, the service area for which is statewide.


As is often the case, there are need determinations for MRI scanners in many counties throughout North Carolina. In 2024, each of the following counties is projected to have a need for one additional fixed MRI scanner:

  • Carteret

  • Cumberland

  • Davie

  • Durham/Caswell/Warren

  • Johnston

  • Lenoir

  • Mecklenburg

  • Orange

  • Pitt/Greene/Hyde/Tyrrell

  • Union

  • Wake

PET Scanners:

The need determination for fixed PET scanners is established on a Health Service Area (HSA)-wide basis. HSA III (in and around the Charlotte area) shows a need for one additional fixed PET scanner.

Long-Term Care

Skilled Nursing Beds:

There is no need for additional skilled nursing beds anywhere in the State.

Assisted Living Beds:

There are needs for additional assisted living beds in two predominantly rural counties:

  • Hoke: 130

  • Swain: 20

Medicare-Certified Home Health Agencies:

Following the 2023 SMFP’s need determination for Medicare-certified home health agencies in several counties, the draft 2024 SMFP shows there is only one county with a need for an additional Medicare-certified home health agency:

  • Cleveland: 1

Hospice Home Care Office and Hospice Inpatient Beds:

There is no need in North Carolina for additional hospice home care offices or hospice inpatient beds.

Burn ICU Beds and Bone Marrow Transplantation Services:

As has been the case for many years, there is no need determination for additional burn ICU beds or bone marrow transplant programs anywhere in North Carolina.

Inpatient Rehabilitation:

There are no need determinations for additional inpatient rehabilitation beds.


Under the county need methodology, there is no need for any additional dialysis stations anywhere in North Carolina. Individual facilities may, however, show a need for additional stations via the facility need methodology. 

Services that do not have need Methodologies

Some health care services do not have need methodologies in the SMFP but are nevertheless regulated by the SMFP. These include: (1) mobile MRI scanners; (2) mobile PET scanners; (3) open heart surgery services and heart-lung bypass machines; (4) solid organ transplantation; (5) mobile cardiac catheterization; and (6) gamma knife. A provider who wishes to add these services must file a summer petition. In 2022, a successful petition generated a need in the 2023 SMFP for two mobile MRI scanners, which has a statewide service area.


2024 promises to yield many new need determinations for a wide range of healthcare assets, which will lead to the filing of CON applications by providers who would like to provide the services determined to be needed. DHSR will determine the CON application filing schedule in the fall of 2023. Petitions to adjust draft need determinations are due on July 26, 2023. Petitions are instrumental in the development of the SMFP.

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