Mississippi doubles its Certificate-of-Need dollar thresholds

Mississippi has doubled the dollar thresholds that trigger a Certificate of Need. House Bill 3, approved by Governor Tate Reeves on February 4, 2026, raises the major-medical-equipment CON trigger from $1.5 million to $3 million and the capital-expenditure trigger for clinical health services from $5 million to $10 million.

The increases sit in the bill’s amendments to Section 41-7-173 of the Mississippi Code. In the definition of “capital expenditure” for defined major medical equipment, the bill strikes “One Million Five Hundred Thousand Dollars ($1,500,000.00)” and inserts “Three Million Dollars ($3,000,000.00).” The parallel definition of “major medical equipment” itself makes the same $1.5M-to-$3M change. For capital expenditures other than major medical equipment, the clinical-services threshold moves from “Five Million Dollars ($5,000,000.00)” to “Ten Million Dollars ($10,000,000.00),” and the non-clinical threshold moves from “Ten Million Dollars ($10,000,000.00)” to “Twenty Million Dollars ($20,000,000.00)” — each verbatim from the enrolled bill text. Every one of the four figures is exactly doubled. The same edit also removes the “adjusted for inflation as published by the State Department of Health” language that had qualified the old non-clinical figure.

What the bill does not do is take surgery off the CON list. The enumerated activities in Section 41-7-191 still include “Open-heart surgery services” at subparagraph (d)(i) and “Ambulatory surgical services” at (d)(xi). A new ASC, or a center newly offering ambulatory surgical services that it has not provided in the prior twelve months, still requires a CON regardless of cost. The thresholds govern the capital-and-equipment trigger, not the service-line trigger.

The operator effect is on capital projects under those caps. An equipment purchase priced up to $3 million, or a clinical build-out under $10 million in total capital, no longer crosses the dollar trigger that would pull it into CON review — the months of application, comment, and contested-hearing exposure that review can carry. The bill, which also addresses several facility-specific CON questions unrelated to ASCs, states that it takes effect “from and after its passage”, and the governor approved it on February 4. Mississippi operators sizing a 2026 expansion should re-check any project that was scoped against the old $1.5M and $5M lines: some that needed a CON last year do not now.