Two health systems have appealed certificate-of-need approvals for hospital expansions in North Carolina after two competing systems — Mission Health and Novant Health — won approval.
Seven things to know:
1. Altamonte Springs, Fla.-based AdventHealth and Chapel Hill, N.C.-based UNC Health separately filed appeals April 24 to contest the certificate-of-need approvals for Asheville, N.C.-based Mission Health, part of Nashville, Tenn.-based HCA Healthcare, and for Winston-Salem, N.C.-based Novant Health.
2. The North Carolina Department of Health and Human Services’ “2025 State Medical Facilities Plan” identified a need for 129 acute care beds in the Buncombe, Graham, Madison and Yancey multicounty service area, with decisions issued March 27. Mission Health was approved to add 95 beds to a patient tower on its main campus, and Novant Health was approved to build Novant Health Asheville Medical Center, a 34-bed community hospital.
3. AdventHealth filed an application to add 129 acute care beds to its planned hospital in Weaverville, N.C., bringing the total capacity to 222 beds. Although the application met certificate-of-need review criteria, it was not selected following the state’s review of competing proposals.
4. UNC Health and Hendersonville, N.C.-based UNC Health Pardee applied to build a 129-bed hospital in Buncombe County. The health department said it did not sufficiently demonstrate need for the project and outlined concerns regarding patient projections and plans to serve medically underserved populations.
5. In its appeal, AdventHealth said the regulators “erroneously determined” the Mission Health and Novant Health applications met all the criteria and argued the systems did not demonstrate need and would unnecessarily duplicate existing services. The appeal also cites Mission Health’s recent immediate jeopardy designations from CMS. AdventHealth is asking an administrative law judge to issue a final decision finding that the two applications did not meet the necessary criteria, reverse the approvals and award AdventHealth a certificate of need.
An AdventHealth North Carolina spokesperson said the appeal was filed because the system does not believe the decision reflects the full scope of community need.
“Construction on phase one of AdventHealth Weaverville is moving forward, supported by the 67 beds already approved by the State,” the spokesperson said. “The additional 26 beds approved in 2024 remain in the appeals process, and we anticipate a decision from the State Administrative Court in the near future. These beds are an important part of our plan to responsibly grow capacity and services.”
AdventHealth intends to apply for the 92 additional acute care beds identified as needed in the 2026 State Medical Facilities Plan.
“Together, these efforts reflect a continued commitment to meeting the region’s growing healthcare needs and ensuring families have access to the care they need, where they need it,” the spokesperson said.
6. UNC Health is also requesting a contested case hearing and argues both Mission Health and Novant Health’s approvals, along with its own disapproval, should be overturned. The system is asking an administrative law judge to award a certificate of need to UNC Health.
“We are proud of our UNC Health West proposal to build a 129-bed hospital and provide a safe, high-quality alternative for the people of western North Carolina,” a health system spokesperson said in a statement shared with Becker’s. “We believe it’s the best approach to serve the future healthcare needs of that region.”
7. A Mission Health spokesperson shared the following statement with Becker’s:
“We are pleased that the North Carolina Department of Health and Human Services Division of Health Service Regulation approved Mission Hospital to add 95 inpatient beds to its Asheville campus, affirming the essential and critical care we continue to provide to western North Carolina. We look forward to alleviating bed capacity constraints so that patients can get the high-quality, advanced care services only Mission can provide.”
An administrative law judge will hear the appeals and has 270 days to issue a decision, BPR reported April 29.
Becker’s has reached out to Novant Health and will update this story if more information becomes available.
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