Proposal Would Remove Bureaucratic Barrier to Healthcare Expansion

March 21, 2026

Delaware House Republican Caucus

"Delaware is growing fast, getting older, and our healthcare system is already behind," said State Rep. Bryan Shupe, the prime sponsor of House Bill 318.

The measure seeks to remove the requirement that hospitals secure government permission to expand, purchase equipment, or build new facilities.

Healthcare organizations considering a significant project must currently submit a "letter of intent" to the Delaware Health Resources Board, which evaluates the proposal and holds hearings to determine whether it serves the public interest. If it approves, the board issues a Certificate of Public Review (CPR), which allows the initiative to move forward. 

This approach is common in the U.S., with most states operating Certificate of Public Review or Certificate of Need (CON) programs. Supporters say the formal review ensures public scrutiny of health care developments and focuses on balancing concerns for access, cost, and quality.

However, Rep. Shupe and other critics maintain that the mechanism is an outdated bureaucratic device that significantly slows the building of critical healthcare infrastructure and hinders Delaware healthcare providers from addressing service gaps.

Rep. Shupe said Delaware is already behind the curve, noting our state has the 5th-oldest and 6th-fastest-growing population in the country. He said healthcare organizations need to be given the freedom to be more responsive and to make their own resource-allocation decisions — without government interference.

While more than 30 states have CPR and CON programs, the landscape is actively shifting. In 2023–2024 alone, at least 22 states reportedly passed legislation modifying such programs. Three years ago, South Carolina repealed nearly all its CON requirements. Georgia, Iowa, Oklahoma, and Washington created exemptions specifically for psychiatric facilities, while Iowa, Tennessee, and Massachusetts commissioned studies to evaluate if their CON programs are still effective

House Bill 318 has been assigned to the House Health & Human Development Committee for consideration.