Four health systems competed for an acute care bed expansion in North Carolina under the state’s certificate-of-need process, with regulators approving applications from Mission Hospital and Novant Health and not selecting applications from UNC Health and AdventHealth, according to March 27 certificate-of-need decisions from the North Carolina Department of Health and Human Services provided to Becker’s.
The department’s “2025 State Medical Facilities Plan” identified a need for 129 acute care beds in the Buncombe, Graham, Madison and Yancey multicounty service area. The review began Nov. 1, and decisions were issued March 27. The appeal deadline is April 27.
1. UNC Health
Chapel Hill, N.C.-based UNC Health and Hendersonville, N.C.-based UNC Health Pardee filed a certificate-of-need application to develop a seven-floor, 129-bed hospital in Buncombe County. However, state regulators said the health system did not sufficiently demonstrate need for the project, citing concerns with its patient projections — including assumptions about drawing patients from areas with existing hospital capacity — as well as expected use of the facility and plans to serve medically underserved populations.
UNC Health stood behind the application.
“We believe our application met the applicable criteria and made a strong case for this project,” a spokesperson said in a statement shared with Becker’s. “We are reviewing the decision and evaluating our options, including a possible appeal.”
2. Mission Health
Asheville, N.C.-based Mission Health, part of Nashville, Tenn.-based HCA Healthcare, proposed adding four floors to a patient tower on its main campus to accommodate additional acute care beds. The project was approved for 95 beds.
State regulators approved the application after finding it consistent with certificate-of-need review criteria, including demonstrating need for additional capacity in the region.
Mission Health 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.”
3. Novant Health
Winston-Salem, N.C.-based Novant Health applied to build Novant Health Asheville Medical Center, a 34-bed community hospital in Buncombe County’s Arden area. The planned facility would include an emergency department, imaging, laboratory and pharmacy services on a 24-acre site, according to an April 10 news release shared with Becker’s. The hospital is slated to open in 2030, subject to the state’s standard appeal process.
The approval comes as Novant continues expanding in western North Carolina. The health system recently completed the first phase of Novant Health South Asheville Medical Park, a 38,000-square-foot site that includes specialty clinics and procedural space, according to the release.
State regulators said the application met certificate-of-need requirements, including demonstrating need for additional beds and outlining plans to expand access to care in the region.
“These milestones represent the beginning of a new chapter for Novant Health in Buncombe County — one that expands choice and improves access to care,” Carl Armato, president and CEO of Novant Health, said in the release. “For decades, we’ve built successful, high-quality community hospitals that meet people where they live, and we’ve been steadfast in our commitment to bring that same model to Western North Carolina.”
4. AdventHealth
Altamonte Springs, Fla.-based AdventHealth applied to expand its planned hospital in Weaverville, N.C., in Buncombe County, by adding acute care beds, increasing the facility’s total capacity to up to 222 beds. The project was not selected.
While the application met certificate-of-need review criteria, it was not approved following the state’s comparative review of competing proposals.
AdventHealth said it is evaluating its next steps following the decision.
“AdventHealth’s commitment to serving Western North Carolina remains unchanged,” the system said in a statement shared with Becker’s. “We are deeply grateful for the community’s continued support throughout this journey, and we remain fully invested in advocating for the people of Buncombe, Graham, Madison and Yancey counties.”
The system said it does not believe the decision is in the best interest of the community and could have significant effects, adding that it is evaluating appeal options.
AdventHealth also said phase one of its Weaverville, N.C., hospital is under construction. The project is part of a broader plan to expand inpatient capacity and bring advanced trauma and tertiary care services closer to home in the region.
Editor’s note: This article was updated April 10.
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