Dear CON Family,

Autumn is my favorite time of year. I look forward to cooler weather, football games, and upcoming holidays. The Cubs just making it to the post season makes it even sweeter. For my family, it is a time of getting back in routines. My 13-year-old started 8^th grade or is finishing his final year of middle school, depending how one looks at it. My wife and I saw his school development lag during Covid. We are proud of the hard work he has put in to overcome that educational deficit in order to meet his peers this year to graduate with them. Next year he starts high school – one challenge at a time, right?

As I look back at my son’s journey, I realize that it’s similar to what many of us experience, especially during fall when we are all getting back to routines. We remember what worked in prior years and what we need to do better. For my son, it was not the material that held him back. We found that teaching him how to study and how to be organized was really what he needed, essentially how to plan. Now, in his final year of elementary/middle school, he is walking tall and with confidence. As I look at the CON program and evaluate what is next or how to proceed, I feel the pride of what our small but mighty staff has been able to do in partnership with the Health Care industry. Despite the hiccups along the road and the pending program sunset (2029), I/we can walk tall knowing we have worked to increase the overall number of Board members who really understand health care delivery. We have an ongoing arduous process of reviewing and updating our rules, in the Health Facilities Planning Act, and internal processes. We have two incredible project reviewers who are getting more support in order to focus more directly on project review. Our data collection and reporting are in the middle of getting caught up and upgraded. Finally, we have a smart and steady hand (legal oversight) guiding our Board by our General Counsel. In these last 19 months Ms. Dominguez has provided the program with a degree of consistency that has not been apparent since I started in 2022.

Although I am happy to see that the program has come this far, just like my son looking forward to new beginnings next year and going to high school, I too see there are new paths to cross. Health care is changing. This might be the most cliché phrase ever used. As much as it has changed in the past 10 years, it is changing that much more in the next few. We have pressures locally and nationally. I want you to know that I am very introspective. I do not want the program to be a further encumbrance to health care or to business. And there lies the rub: How can a Certificate of Need program assure both?  

I believe it can be done. We must work so delays are minimal in time and cost. We must be flexible to accommodate reasonable requests, while providing consistency and predictability. We must continue to modernize our rules and ensure they are reflective of the industry’s trajectory so providers can be innovative, and the people of Illinois can access quality services. For those of you who I have had the privilege to work with and for, you know that I do this through open, honest and sometimes painful conversation. 

In the previous newsletter, I stated that my philosophy was to cultivate a “philosophy of adherence to rules and process, without losing sight of real-world market pressures." In practice, this philosophy aims to make the regulatory process as close to real market situations as possible, while promoting access to services, as well as planning and development principles. As we look at our rules and updates, my focus is on how to guide this regulatory process, a process that is needed to ensure orderly and essential healthcare services are developed, safety net providers are maintained, and the underserved, underinsured, or uninsured have access to quality care. I believe all this can be accomplished while allowing the healthcare providers to be nimble enough to adjust to industry changes, promote innovation, and balance accessibility with sustainability.

While I believe the symbiosis of planning and the business of health care can be achieved, it is a vision that is ever changing and only through communication can this be accomplished. How the services are delivered is changing. There is a greater focus on outpatient care and continued pushing services to care models that are less acute. This is not an attack on hospitals or providers but the realization that how care is delivered and paid for is changing. I think it is more incumbent upon us to recognize the levels of care and to be a partner to the health care delivery systems within Illinois to implement and support the changing dynamics.

Therefore, I ask each of you to work with me in this journey of evolution. The HFSRB is a tool of planning that creates predictability and consistency. Thank you to all that I have had the pleasure of communicating with in this past year. I look forward to continued collaboration and communication as Illinois and health care evolve. Let’s plan together.

Sincerely yours,



John P. Kniery



During the Spring 2025 legislative session, the Illinois General Assembly passed two bills that affect HFSRB, including:

These changes include:

Rulemaking Updates

Preparing for Medicaid Cuts - CHOWs, Temporary Suspensions, and Discontinuations

While we all hope for the best, the recent enactment of the One Beautiful Bill Act (OBBBA) has undoubtedly caused considerable concern for healthcare providers in Illinois. Last month, Becker’s Hospital Review reported that Illinois is among the hardest hit nationally under the OBBBA. According to a report compiled by KFF, Illinois faces Medicaid cuts of nearly 20%. A July 8, 2025, press release from Gov. JB Pritzker estimated that 330,000 Illinois residents could lose Medicaid coverage because of the proposed cuts in OBBBA.

Illinois is not alone. Industry experts project that federal Medicaid funding cuts will adversely affect healthcare facilities’ operating margins, increase scrutiny from payers, and force healthcare providers nationwide to manage costs, streamline services, and explore collaborations with other providers to share the burden. 

This means that healthcare providers in Illinois may soon have to make tough decisions about the best way to move forward. These decisions may require temporary or long-term changes to the healthcare provider’s categories of service or the entire facility. 

HFSRB staff wants to remind healthcare providers and Certificate of Need (CON) consultants about the need to file appropriate notices and/or applications as they assess their facilities. These may include:

• Change of ownership (CHOW) — Healthcare providers may seek to alleviate some of their financial concerns by exploring mergers, acquisitions, transfers, sales/leases, etc. These types of transactions could trigger the need to file a certificate of exemption (COE) to fulfill the requirements in the Illinois Health Facilities Planning Act [20 ILCS 3960] and its governing administrative rules in Title 77 of the Illinois Administrative Code. 
• Temporary suspension of one or more categories of service or an entire facility—A temporary suspension offers healthcare facilities a valuable tool when they merely need to “pause” operations to allow a facility to halt some or all operations for up to 12 months without being classified as a discontinuation. A temporary suspension is intended to give a healthcare provider time to address issues that will hopefully lead to the resumption of the suspended services or facility.
• Chronic low utilization of categories of service or an entire facility may lead to long-term discontinuation/closure. Discontinuing one or more categories of services or closing a whole facility requires the filing of a CON or COE application.

HFSRB staff encourage all healthcare providers in Illinois to keep these options in mind as they conduct their financial stress tests and review their ownership structure and agreements. Undertaking a change of ownership or a discontinuation, even temporarily, without filing the proper notices or applications, may result in a noncompliance action. 



If your organization is contemplating these options, now is the time to reach out to HFSRB staff to discuss your plans and obtain guidance on complying with the statutory and regulatory requirements. 

A referral letter for the Illinois Health Facilities and Services Review Board (HFSRB) must contain specific, notarized information to help prove the need for a proposed project. The requirements vary by project type; however, the following are key components, particularly for new facilities such as Ambulatory Surgical Treatment Centers (ASTCs). 

Mandatory components of a PHYSICIAN referral letter

• The letter must include the name and specialty of the referring physician.
• The physician's signature must be notarized.
• The office address must be included.
• Document the total number of patients the physician has referred to existing facilities (hospitals or ASTCs) within the Geographic Service Area (GSA) during the 12-month period before the application was submitted.
• The patient's origin information, including the zip code of residence, must be included.
• State the estimated number of patients the physician will refer to the new or expanded facility within 24 months after the project is completed.
• The physician must verify that the projected patient volume is within the defined GSA.
• The letter must explicitly state that the referrals cited have not been used to support any other pending or approved Certificate of Need (CON) application for the same services. 

David Fox has served on the Health Facilities & Services Review Board since 2021, but he is no stranger to the Board. Mr. Fox served as a health care executive for 41 years and presented projects before the Board over 20 times. Mr. Fox believes that projects ought to be well-considered to avoid unnecessary duplication of services throughout the state. Mr. Fox approaches his work on the Board guided by his philosophy of giving back and with his comprehensive experience in the Certificate of Need process.

For information on the deadlines associated with pending projects, please make sure to check out the "Project Search" tab on the HFSRB website by clicking here



Access information about the Certificate of Need process and Application materials by clicking here