This bill modifies Kentucky’s certificate of need (CON) regulations, focusing on creating a four-year pilot program for urban health care markets while making several changes to existing healthcare facility and service review processes. The bill redefines and expands exemptions from certificate of need requirements, including new categories like medical imaging equipment, certain ambulatory surgical centers, and specific healthcare facility relocations. It requires the Cabinet for Health and Family Services to grant nonsubstantive review for certain healthcare proposals instead of merely permitting it, and introduces a presumption of need and state health plan consistency for nonsubstantive review applications. The pilot program, starting January 1, 2026, will apply to urban counties with populations over 100,000 and hospitals exceeding 30,000 inpatient days annually, offering more flexible CON requirements for these areas. The bill prohibits the cabinet from “batching” applications for similar services and requires annual reporting on the pilot program’s progress. The goal is to potentially increase healthcare access and service flexibility in urban markets, with insights from the pilot potentially informing future statewide healthcare policy changes.