House advances expedited certificate of need process for intermediate care facilities after floor questions

The House approved legislation that creates an expedited certificate of need (CON) procedure for intermediate care facilities, a category of health care provider described on the floor as one step down from a hospital. The bill was on third reading and passed after questions about whether the new framework meaningfully reforms the CON system.

A delegate on the floor asked whether the bill merely creates an expedited route while leaving the ultimate decision to the Maryland Health Care Commission (MHCC) in its "sole discretion," a line of the bill that prompted concern about whether reform would be substantive. "It doesn't actually seem to make any germane rule changes if it's leaving it to the sole discretion of the commission," the delegate said.

A floor sponsor explained the measure establishes an expedited CON process intended to shorten review timelines for intermediate care facilities (often serving persons with substance use disorder) while preserving MHCC's authority to verify capacity, staffing and viability. The sponsor said MHCC currently lacks explicit authority to restrict or scrutinize expansions by some intermediate care facilities and that the bill adds application and review requirements and allows expedited handling in cases of demonstrated need.

Some delegates argued for more aggressive CON reform, noting that many states have eliminated CON requirements. "Most states have done away with this completely," one delegate said, announcing a planned negative vote. Others said the bill represents a partial, pragmatic step to speed needed facility expansions while preserving oversight.

The House completed the vote on third reading; the floor tally recorded for the bill on final passage was 128 affirmative votes. The bill now proceeds to enrollment and the governor for consideration.

Sources: Floor questioning and sponsor explanation on March 22, 2025 (House floor).